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The Vermont Model for Rural HIV Care Delivery: Eleven Years of Outcome Data Comparing Urban and Rural Clinics


  • The authors acknowledge the following grant support: Department of Health and Human Services, Health Resources and Services Administration, Special Projects of National Significance, PHS BRU 900109 and H76 HA 00203 (1994-1999); and Department of Health and Human Services, Health Resources and Services Administration, Part C Ryan White Care Act, H76 HA 00203 (1999-2006).

  • The authors also wish to thank the nurses, social workers and dietitian of the clinics for their strong patient care, and Brenda Smith for her assistance with the manuscript preparation. For further information, contact: Christopher Grace, MD, Infectious Diseases Unit, Fletcher Allen Health Care, Smith 275, 111 Colchester Ave, Burlington, VT 05401; e-mail


Context: Provision of human immunodeficiency virus (HIV) care in rural areas has encountered unique barriers.

Purpose: To compare medical outcomes of care provided at 3 HIV specialty clinics in rural Vermont with that provided at an urban HIV specialty clinic.

Methods: This was a retrospective cohort study.

Findings: 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/mm3-350/mm3 vs 182 cells/mm3-379/mm3). 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]).

Conclusions: 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.