Quality of medical care and treatment among HIV-infected women in rural California

Background: HIV is increasingly affecting women in rural areas, but the quality of care available to such women varies. This study aimed to evaluate if women in rural areas of California are receiving recommended medical care. Methods: Medical record abstraction of 64 HIV-infected women living in rural areas. Eleven hospitals were randomly sampled and all HIV-infected female patients seeking care during 4 months of 2007 were eligible. Results: 94% of these women ever took antiretrovirals, and 89% were currently taking ARVs. PIs (30%), NRTIs (29%), and combination therapy (20%) were most frequently used. 36% of women had ever progressed to AIDS. 75% had their first CD4 counts within a year of their first positive HIV test. The initial CD4 counts were <200 for 27% of women and >500 for 35%; the most recent CD4 showed only 5% < 200 and 65% >500. Within one year of diagnosis, 17% of the women's viral loads were reduced to undetectable levels and another 25% had this reduction within 1 to 5 years. 19% of the women had any history of opportunistic infection, primarily PCP. Most subjects received influenza (89%), Pneumococcal (84%) and Hepatitis B (56%) vaccines. Conclusions: Most women in this study were able to access ARVs and other recommended medical care, which may have prevented opportunistic infections and advancement to AIDS. However, the viral load results and rate of combination therapy suggest a need for enhanced care. Possible strategies to improve care, drawn from the literature and current findings, will be discussed.