The Health Resources and Services Administration’s Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes

Abstract Background The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)’s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the “Ending the HIV Epidemic: A Plan for America” (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. Methods The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. Results During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. Conclusions The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.

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Assessing clinical quality performance and staffing capacity differences between urban and rural Health Resources and Services Administration-funded health centers in the United States: A cross sectional study

PLoS ONE ◽

10.1371/journal.pone.0242844 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0242844

Author(s):

Nadereh Pourat ◽

Xiao Chen ◽

Connie Lu ◽

Weihao Zhou ◽

Hank Hoang ◽

...

Keyword(s):

United States ◽

Low Income ◽

Rural Areas ◽

Health Resources ◽

Quality Measures ◽

The United States ◽

Health Centers ◽

Quality Performance ◽

Clinical Quality

Background In the United States, there are nearly 1,400 Health Resources and Services Administration-funded health centers (HCs) serving low-income and underserved populations and more than 600 of these HCs are located in rural areas. Disparities in quality of medical care in urban vs. rural areas exist but data on such differences between urban and rural HCs is limited in the literature. We examined whether urban and rural HCs differed in their performance on clinical quality measures before and after controlling for patient, organizational, and contextual characteristics. Methods and findings We used the 2017 Uniform Data System to examine performance on clinical quality measures between urban and rural HCs (n = 1,373). We used generalized linear regression models with the logit link function and binomial distribution, controlling for confounding factors. After adjusting for potential confounders, we found on par performance between urban and rural HCs in all but one clinical quality measure. Rural HCs had lower rates of linking patients newly diagnosed with HIV to care (74% [95% CI: 69%, 80%] vs. 83% [95% CI: 80%, 86%]). We identified control variables that systematically accounted for eliminating urban vs. rural differences in performance on clinical quality measures. We also found that both urban and rural HCs had some clinical quality performance measures that were lower than available national benchmarks. Main limitations included potential discrepancy of urban or rural designation across all HC sites within a HC organization. Conclusions Findings highlight HCs’ contributions in addressing rural disparities in quality of care and identify opportunities for improvement. Performance in both rural and urban HCs may be improved by supporting programs that increase the availability of providers, training, and provision of technical resources.

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AIDS in the United States by Geographic Distribution: CDC HIV/AIDS Facts

PsycEXTRA Dataset ◽

10.1037/e617962010-001 ◽

2009 ◽

Cited By ~ 1

Keyword(s):

United States ◽

Geographic Distribution ◽

The United States ◽

Hiv Aids

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Reducing HIV-Related Health Disparities in the Health Resources and Services Administration’s Ryan White HIV/AIDS Program

American Journal of Public Health ◽

10.2105/ajph.2018.304689 ◽

2018 ◽

Vol 108 (S4) ◽

pp. S246-S250 ◽

Cited By ~ 21

Author(s):

Paul Mandsager ◽

Allison Marier ◽

Stacy Cohen ◽

Miranda Fanning ◽

Heather Hauck ◽

...

Keyword(s):

Health Disparities ◽

Health Resources ◽

Ryan White ◽

Aids Program ◽

Hiv Aids

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HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration’s Ryan White HIV/AIDS Program: A retrospective study

PLoS Medicine ◽

10.1371/journal.pmed.1003125 ◽

2020 ◽

Vol 17 (5) ◽

pp. e1003125

Author(s):

Pamela W. Klein ◽

Demetrios Psihopaidas ◽

Jessica Xavier ◽

Stacy M. Cohen

Keyword(s):

Retrospective Study ◽

Health Resources ◽

Transgender Women ◽

People Living With Hiv ◽

Women Living With Hiv ◽

Ryan White ◽

Aids Program ◽

Living With Hiv ◽

Hiv Aids

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Financial, Food, and Housing Insecurity Due to Coronavirus Disease 2019 Among At-Risk People With Human Immunodeficiency Virus in a Nonurban Ryan White HIV/AIDS Program Clinic

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa423 ◽

2020 ◽

Vol 7 (10) ◽

Cited By ~ 1

Author(s):

Jacqueline E Sherbuk ◽

Brooke Williams ◽

Kathleen A McManus ◽

Rebecca Dillingham

Keyword(s):

United States ◽

At Risk ◽

Human Immunodeficiency Virus ◽

Social Determinants Of Health ◽

Social Determinants ◽

Southern United States ◽

Immunodeficiency Virus ◽

Ryan White ◽

Aids Program ◽

Hiv Aids

Abstract Coronavirus disease 2019 negatively impacts social determinants of health that contribute to disparities for people with human immunodeficiency virus (HIV). Insecurity of food, housing, and employment increased significantly in April 2020 among patients with lower incomes at a Ryan White HIV/AIDS program clinic in the Southern United States.

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Rural Chronic Disease Research Patterns In The United Kingdom, United States, Canada, Australia And New Zealand: A Systematic Integrative Review

10.21203/rs.2.18137/v2 ◽

2020 ◽

Author(s):

Rebecca Disler ◽

Kristen Glenister ◽

Julian Wright

Keyword(s):

United States ◽

United Kingdom ◽

New Zealand ◽

Chronic Disease ◽

Health Outcomes ◽

Clinical Outcomes ◽

Rural Areas ◽

The United States ◽

Models Of Care ◽

The United Kingdom

Abstract Background People living in rural communities commonly experience significant health disadvantages. Geographical barriers and reduced specialist and generalist services impact access to care when compared with metropolitan context. Innovative models of care have been developed for people living with chronic diseases in rural areas with the goal of overcoming these inequities. This review aims to describe the state of knowledge regarding innovative models of care and clinical outcomes for people living with chronic disease in rural areas in developed countries where a metropolitan comparator is included. Methods An integrative systematic review was undertaken. P referred R eporting I tems for S ystematic Reviews and M eta- A nalyses (PRISMA) method was used to understand data on clinical outcomes for people living with chronic disease in rural compared with metropolitan contexts and their models of care in Australia, New Zealand, United States, Canada and the United Kingdom Results Literature searching revealed 620 articles published in English between 2000 and 2019. 160 were included in the review including 68 from the United States, 59 from Australia and New Zealand (5), 21 from Canada and 11 from the United Kingdom and Ireland. 53% (84) focused on cardiovascular disease; 27% (43) diabetes mellitus; 8% (12) chronic obstructive pulmonary disease; and 13% (27) chronic kidney disease. Mortality was only reported in 10% (16) of studies and only 18% (29) reported data on Indigenous populations. Conclusions This integrated review reveals published literature on common chronic health issues pertaining to rural and remote populations is largely descriptive. Only a small number of publications focus on mortality and comparative health outcomes from health care models in both urban and non-urban populations. Innovative service models and telehealth are together well represented in the published literature but data on health outcomes is relatively sparse. There is significant scope for further directly comparative studies detailing the effect of service delivery models on the health outcomes of urban and rural populations. We believe that such data would further knowledge in this field and help to break the deadly synergy between increased rurality and poorer outcomes for people with chronic disease.

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