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.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Health Services Accessibility*; Delivery of Health Care/*standards ; HIV Infections/*therapy ; Patient Protection and Affordable Care Act/*statistics & numerical data ; Rural Health Services/*statistics & numerical data ; United States Health Resources and Services Administration/*statistics & numerical data; Adolescent ; Adult ; Aged ; Female ; Financial Management ; Geography ; HIV/isolation & purification ; HIV Infections/diagnosis ; HIV Infections/economics ; HIV Infections/epidemiology ; Humans ; Male ; Middle Aged ; Patient Protection and Affordable Care Act/organization & administration ; Patient Protection and Affordable Care Act/standards ; Residence Characteristics ; Rural Health Services/organization & administration ; Rural Health Services/standards ; Transgender Persons ; Treatment Outcome ; United States/epidemiology ; United States Health Resources and Services Administration/organization & administration ; United States Health Resources and Services Administration/standards ; Young Adult

Background: People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration's Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas.
Methods and Findings: Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service ("RWHAP providers") were categorized as rural or non-rural according to the HRSA FORHP's definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as "visited only rural providers," "visited only non-rural providers," or "visited rural and non-rural providers." In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1-99 clients, while 29.6% of non-rural providers served 1-99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers.
Conclusions: RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.
Competing Interests: The authors work for the federal agency that implements the Ryan White HIV/AIDS Program which is the subject of this paper.

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Date Created: 20200324 Date Completed: 20200619 Latest Revision: 20200619

20240105

PMC7089565

10.1371/journal.pone.0230121

32203556