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HIV HEART Exit Disclaimer (Health, Education, Assessment, and Research in Telehealth) is another TTCP grantee. One aspect of the program involves providing virtual training for rural providers throughout Arkansas, Mississippi, and Louisiana via quarterly interactive video conferences, which highlight HIV best practices using a case study format. Another aspect involves one-on-one telemedicine consultations. Virtual technology allows HEART’s Clinical Director Jon Allen to “sit in” on a patient visit and then advise the provider regarding that individual’s care.

Virtual programs like these greatly increase the ability of busy rural clinicians to provide high-quality HIV care. “In one small town in Eastern Mississippi, there’s just one doctor providing care for the whole town,” says Sarah Rhoads Kinder, HEART’s principal investigator. “He told us that he hasn’t taken a vacation in 3 years!”

Whether PLWHA are traveling to avoid stigma or to access quality care, they can face lengthy ordeals. The ability to access quality care close to home is an important part of remaining engaged in care. Rural providers face their own travel barriers; they rely on telehealth programs because they simply don’t have the time to travel for needed training and education. By easing these burdens, AETC telehealth training has made a real difference for HIV/AIDS clinics and PLWHA alike.

The ability to access quality care close to home is an important part of remaining engaged in care. This work is being furthered under HRSA’s Office of Rural Health Policy Office for the Advancement of Telehealth, which promotes the use of telehealth technologies for health care delivery, education, and health information services, and provides funding for telehealth grants and resource centers.

Hope for the Future

For more than 20 years, the Ryan White HIV/AIDS Program has been a lifeline for rural populations. The Ryan White HIV/AIDS Program bridges long distances by funding transportation services, training local providers in HIV/AIDS care, and underwriting telehealth programs. Part B, Part C, and Part D have all bolstered medical services in these areas, helping to provide ongoing care for those who need it most. AETCs provide a national infrastructure of training and education.

There are many reasons to be hopeful about the future of HIV/AIDS in rural areas. The Internet is providing forums for rural PLWHA to engage easily with other people who have the disease. Rapid testing is enabling instant diagnosis for patients, while also helping clinicians link newly diagnosed people to care more quickly. Powerful new combination drugs greatly simplify the drug regimens that PLWHA must follow, which means that monitoring patients’ health is less cumbersome. These developments bring rural HIV care closer to the point where it is no longer dependent on infectious disease doctors based in urban centers.

“The newer drugs make it much easier in communities that don’t have a lot of expertise,” explains Dr. Robert Harrington, medical director for the Ryan White-funded Harborview Madison Clinic in Seattle, WA. “If the treatment is relatively easy and convenient, it’s something that most primary care providers can do.”

Harrington envisions a world where primary care doctors are equipped to treat most cases of HIV, referring only more extreme cases to specialists. That may one day be the legacy of the Ryan White HIV/AIDS Program in rural areas—creating an infrastructure in which cases of HIV/AIDS are passed seamlessly through the necessary channels of care as if they were no different than a more common ailment. In this sense, says Harrington, demystifying the disease and refusing to act as if HIV requires some special set of procedures are the keys to eradicating the disease.

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