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How can quality of care for HIV-positive and AIDS patients be improved? For those in Robeson County, NC, a new community-based infectious disease clinic has eliminated a five-hour drive to facilities at University of North Carolina at Chapel Hill (UNC-CH).
Infectious disease experts at the UNC-CH School of Medicine started the clinic in January 2001 after examining the number of patients treated at the Chapel Hill-based facility, says Charles van der Horst, MD, UNC-CH professor of medicine and infectious diseases and medical director of the University of North Carolina AIDS Clinical Trials Unit. The AIDS Clinical Trials Unit conducts and develops research of HIV infection and its associated opportunistic infections and provides access to promising clinical protocols to persons living with HIV.
The Chapel Hill clinic follows 1,500 patients, says van der Horst. In examining its patient population, clinic officials determined that 10% of its patients were coming from Robeson County. The idea for initiating a community-based clinic came from UNC-CH providers’ desire to locate services closer to those impacted by the HIV/AIDS epidemic.
"If you’re a single mother, for example, who is infected with HIV, the virus that causes AIDS, you shouldn’t have to drive so far for a 15-minute doctor’s appointment, especially if you don’t own a car," says van der Horst.
Robeson County, while not among North Carolina’s most populous counties, has been disproportionately impacted by sexually transmitted diseases, including syphilis, states van der Horst.
High syphilis rates are of concern, since infection increases HIV transmission at least two- to fivefold, according to the Atlanta-based Centers for Disease Control and Prevention (CDC).1 In 1998, Robeson County ranked 28th in the nation in new cases of infectious syphilis.2 Half of its cases were among African-Americans, with 41% among Native Americans, according to the CDC.2
Providing care to HIV/AIDS patients requires specific services, says van der Horst. The skills needed to obtain and provide drugs, manage individual cases, and provide other services have made care a very specialized, complicated business, he notes. By developing a community clinic staffed with providers experienced with HIV/ AIDS, patients now receive the services they need at a convenient location.
A $100,000 grant from the N.C. Department of Health and Human Services in Raleigh, made possible by federal monies from the Ryan White bill, were secured for the clinic’s first year of operations. Medicaid, private insurance, Medicare and the federal AIDS Drug Assistance Program cover indigent patients’ costs. The clinic also provides financial assistance to a few patients who need help with drug costs, van der Horst said.
Each week, Dickens Theodore, MD, or Becky Stephenson, MD, members of UNC-CH’s department of medicine faculty, accompany UNC-CH family nurse practitioner Laurie Frarey, FNP, to Lumberton to see patients at the clinic. All services are HIV health care-related; no primary care is provided, says Stephenson.
The clinic has been promoted in the local paper and on UNC-TV, and case managers for the HIV-infected patients have notified the local providers, says Stephenson.
"We also had a reception with the local providers before we started," she notes. "The reception has been very positive."
The clinic’s first patient was a newly diagnosed woman in the third trimester of pregnancy, says van der Horst. Knowing that a baby’s life has been saved due to the clinic’s care is "worth the whole grant," he says.
When adequate care for people with HIV infection is not readily available, treatment is often sought in local hospital emergency rooms, observes van der Horst. Such practice is detrimental to patients, since they present with more advanced symptoms, and costly for hospitals, since such care is often not reimbursed.
"This clinic, while a small and modest beginning, is really a landmark opportunity not only to provide compassionate, humane care for those who are often marginalized on the fringes of society, but also to help stop the spread of HIV," van der Horst said. "We hope that it will serve as a catalyst for local communities and medical centers to step forward and help out as well."