Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system

AIDS Behav. 2013 Jan;17(1):250-9. doi: 10.1007/s10461-011-0107-8.

Abstract

Rural persons with HIV face barriers to care that may influence adoption of advances in therapy. We performed a retrospective cohort study to determine rural-urban variation in adoption of raltegravir-the first HIV integrase inhibitor-in national Veterans Affairs (VA) healthcare. There were 1,222 veterans with clinical indication for raltegravir therapy at time of its FDA approval in October 2007, of whom 223 (19.1%) resided in rural areas. Urban persons were more likely than rural to initiate raltegravir within 180 days (17.3% vs. 11.2%, P = 0.02) and 360 days (27.5% vs. 19.7%, P = 0.02), but this gap narrowed slightly at 720 days (36.3% vs. 31.8%, P = 0.19). In multivariable analysis adjusting for patient characteristics, urban residence predicted raltegravir adoption within 180 days (odds ratio 1.72, 95% CI 1.09-2.70) and 360 days (OR 1.63, 95% CI 1.13-2.34), but not 720 days (OR 1.26, 95% CI 0.84-1.87). Efforts are needed to reduce geographic variation in adoption of advances in HIV therapy.

Resumen Personas en zonas rurales con VIH enfrentan barreras medicas que pueden influir la adopción de advances de terapia. Realizamos un estudio de cohorte restrospectivo para determiner la variación en zonas rurales-urbanas y la adopcion de raltegravir-el primer inhibidor de la integrasa del VIH-en hospitales nacionales de la Administración de Veteranos (VA). Había un total de 1,222 veteranos con indicación clínica para la terapia de raltegravir en el momento que fue aprobada for la FDA en Octubre del 2007, de los cuales 223 (19.1%) residían en zonas rurales. Personas en zonas urbanas eran más propensos que personas en zonas rurales en iniciar raltegravir dentro de 180 días (17.3% vs. 11.2%, P = 0.02) y 360 días (27.5% vs. 19.7%, P = 0.02), pero esta diferencia se redujo ligeramente a 720 días (36.3% vs. 31.8%, P = 0.19). Usando un analisis multivariable y ajustando las características del paciente, residencia urbana predijo la adopción de raltegravir dentro de 180 dias (proporción de probabilidades 1.72, 95% de CI 1.09–2.70 y 360 dias (proporción de probabilidades 1.63, 95% CI 1.13–2.34), pero no en 720 días (proporción de probabilidades 1.26, 95% CI 0.84–1.87). Mas esfuerzos son necesario para reducir la variacion geograficos en los advances de terapia del VIH.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • CD4 Lymphocyte Count
  • Child
  • Child, Preschool
  • Delivery of Health Care / trends*
  • Diffusion of Innovation*
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV Integrase Inhibitors / therapeutic use*
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Patient Acceptance of Health Care
  • Pyrrolidinones / therapeutic use*
  • Raltegravir Potassium
  • Residence Characteristics
  • Retrospective Studies
  • Rural Health Services / organization & administration
  • Rural Population
  • Surveys and Questionnaires
  • United States
  • United States Department of Veterans Affairs
  • Urban Population
  • Veterans / statistics & numerical data
  • Viral Load
  • Young Adult

Substances

  • HIV Integrase Inhibitors
  • Pyrrolidinones
  • Raltegravir Potassium