There have been well-established associations between retention in HIV care and improved health outcomes. However, rural people living with HIV/AIDS face unique barriers to retention in care, particularly long travel distances to receive care. Studies have shown that transportation assistance to patients in rural communities can improve retention in care.
In 2009 and 2010, transportation assistance in the form of gas vouchers were provided directly to patients at each visit at Tulane's Alexandria HIV clinic in rural Louisiana. However, between 4/2011- 4/2012, funding cuts forced patients to receive the vouchers indirectly through an offsite agency. We hypothesized that the change from direct transportation assistance to indirect transportation assistance would result in decreased measures of retention in care during that time period, particularly amongst patients who lived outside the city (>10miles)
We performed a retrospective chart review of patients at the Alexandria clinic comparing markers of retention in care during 3 different time periods: 2009, 2010 and the time period 4/2011-4/2012. The markers we used are Visit Constancy (the proportion of 3 months time intervals with at least one completed visit during a 12 month period) and the HRSA HAB clinic visit measure (whether a patient completed 2 or more visits separated by 3 months within a 12 month period). We evaluated patients based on distance from clinic.
On average, there were 343 patients per year and 1602 HIV provider visits per year. 34% of patients lived within 10 miles of clinic, 64.9% of patients lived greater than 10 miles from clinic. In 2009, 2010 and in the period 4/2011-4/2012, 73%, 72.7% and 75% of patients met HRSA criteria for retention in care respectively. In the subgroups of patients who lived >10 miles away from clinic, in 2009, 2010 and 4/2011-4/2012, 73.4%, 71.7% and 73.1% met HRSA retention in care respectively. Furthermore, visit constancy measures improved during the time period 4/2011-4/2012 compared with earlier periods.
We did not find a trend towards decreased retention in care by either the HRSA measure or the Visit Constancy measure based solely on the change from direct to indirect transportation assistance to patients.