Migration to rural areas by HIV patients: impact on HIV-related healthcare use

Abstract

Objective: To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting.

Design: Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use.

Setting: An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection.

Patients: All patients scheduled into clinic reported a previous positive HIV serologic test.

Results: Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the Centers for Disease Control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934.

Conclusions: A substantial portion of HIV-related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.