Infectious Diseases Unit, Fletcher Allen Health Care, Burlington, Vermont 05401, USA.
J Rural Health. 2010 Summer;26(2):113-9. doi: 10.1111/j.1748-0361.2010.00272.x.
Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers.
To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic.
This was a retrospective cohort study.
Over an 11-year period 363 new patients received care, including 223 in the urban clinic and 140 in the rural clinics. Patients in the 2 cohorts were demographically similar and had similar initial CD4 counts and viral loads. There was no difference between the urban and rural clinic patients receiving Pneumocystis carinii prophylaxis (83.5% vs 86%, P= .38) or antiretroviral therapy (96.8% vs 97.5%, P= .79). Both rural and urban cohorts had similar decreases in median viral load from 1996 to 2006 (3,876 copies/mL to <50 copies/mL vs 8,331 copies/mL to <50 copies/mL) and change in percent of patients suppressed to <400 copies/mL (21.4%-69.3% vs 16%-71.4%, P= .11). Rural and urban cohorts had similar increases in median CD4 counts (275/mm(3)-350/mm(3) vs 182 cells/mm(3)-379/mm(3)). A repeated measures regression analysis showed that neither fall in viral load (P= .91) nor rise in CD4 count (P= .64) were associated with urban versus rural site of care. Survival times, using a Cox proportional hazards model, were similar for urban and rural patients (hazard ratio for urban = 0.80 [95% CI, 0.39-1.61; P= .53]).
This urban outreach model provides similar quality of care to persons receiving care in rural areas of Vermont as compared to those receiving care in the urban center.
在农村地区提供人类免疫缺陷病毒（HIV）护理遇到了独特的障碍。
将佛蒙特州 3 家农村 HIV 专科诊所提供的护理医疗结果与城市 HIV 专科诊所进行比较。
这是一项回顾性队列研究。
在 11 年期间，有 363 名新患者接受了治疗，其中 223 名在城市诊所，140 名在农村诊所。这两个队列的患者在人口统计学方面相似，初始 CD4 计数和病毒载量也相似。接受卡氏肺孢子菌预防（83.5%对 86%，P=.38）或抗逆转录病毒治疗（96.8%对 97.5%，P=.79）的城市和农村诊所患者之间没有差异。农村和城市队列的中位病毒载量均从 1996 年至 2006 年下降（3876 拷贝/ml至<50 拷贝/ml 对 8331 拷贝/ml至<50 拷贝/ml），抑制<400 拷贝/ml 的患者比例变化（21.4%-69.3%对 16%-71.4%，P=.11）。农村和城市队列的中位 CD4 计数均增加（275/mm(3)-350/mm(3)对 182 细胞/mm(3)-379/mm(3)）。重复测量回归分析显示，病毒载量下降（P=.91）或 CD4 计数上升（P=.64）均与城市与农村护理地点无关。Cox 比例风险模型的生存时间，城市和农村患者相似（城市的危险比=0.80[95%CI，0.39-1.61；P=.53]）。
与城市中心接受护理的患者相比，佛蒙特州农村地区接受该城市外展模式护理的患者获得了类似的护理质量。
