For PLWHA, dealing with the effects of stigma can be as simple as knowing that they’re not alone in their struggle with the disease. One man in rural Minnesota, for example, felt isolated after losing his partner. A case manager at the Rural AIDS Action Network (RAAN) encouraged him to attend a local support group. At first, he was reluctant to participate, but after continued encouragement, he attended and discovered that several other PLWHA were nearby. He went on to serve on the State’s HIV planning council.
“He’s much more engaged in his care and in his community,” says RAAN Executive Director Charles Hempeck. “I think we played an important role in that.”
Another hopeful sign is the growing popularity of online networks, providing many rural PLWHA with a source of confidential support. The Internet can be a safe place to connect with others and gain access to information, making them feel less isolated and alone.
Telehealth Breaks Down Barriers
In rural areas, long distances represent a major barrier to care. Advances in virtual technology—supported by funding from the Ryan White HIV/AIDS Program—are helping overcome this barrier.
Project ECHO, an innovative telehealth program that includes an online conference call component, gives rural providers invaluable access to a multidisciplinary team of specialists.
Many AETCs across the country have implemented telehealth programs to enable local primary care providers to consult virtually with HIV specialists. This approach is based on an innovative clinical consultation model called Project ECHO® (Extension for Community Healthcare Outcomes), originally developed at the University of New Mexico in Albuquerque.
According to Karla Thornton, associate director of Project ECHO and professor of medicine at the University of New Mexico, the consultative approach creates a “learning loop” that spreads knowledge exponentially in rural areas and beyond. “In our clinics we call it a community of practice: we learn from them, they learn from us, and we learn from each other,” she says. “We’re building capacity within a community.”
To promote widespread adoption of telehealth, HRSA has provided grant funding through the AETC Telehealth Training Centers Program (TTCP). The Northwest AETC ECHO program, one of nine grantees, began a telehealth program almost two years ago. To participate, providers submit patient cases for discussion during weekly real-time, interactive video conferences; alternatively, they simply listen in to gain experience and knowledge around HIV care. “The idea is to connect community-based rural clinicians with a panel of specialists—and to each other,” says Dr. Brian Wood, medical director for the NW AETC and an assistant professor at the University of Washington. This creates a network of support.
One notable case involved an HIV-positive woman who was struggling with medication adherence—as well as other complications, such as latent tuberculosis and syphilis—early in a pregnancy. Her rural provider presented the case to the ECHO panel about seven or eight times over the course of her pregnancy. By the time the baby was born, the mother’s viral load was at its lowest level ever and the baby was born HIV free. “It was just a fantastic outcome,” says Wood.