From Isolation to Telemedicine: Improving Treatment Options for HIV Patients in the Rural South

It's almost springtime in the South, but no amount of sunshine can hide a devastating problem in Selma, Ala. While most Americans live far removed from HIV and its complications, in this town -- and in the Southern region of the United States -- it can't be ignored.

According to the Centers for Disease Control, in 2010, the southern region of the United States saw the highest rate of new HIV infections related to population. In Selma, where, according to the latest census data, 38.1 percent of the population lives below the federal poverty line, feelings of shame and frustration, coupled with limited access to care, converge to form a crippling public health crisis.

It is hard to imagine that we have not yet moved beyond this in 2012. But there's new hope.

Thanks to enhanced medicine and treatment, an HIV diagnosis is no longer a death sentence. Recent data suggest that a 25-year-old person diagnosed with HIV and having no other complicating symptoms -- who immediately enters into consistent, effective, and comprehensive HIV treatment -- can expect to live more than 50 years beyond his or her diagnosis to the age of 77 -- roughly the same life expectancy as someone who does not have HIV.

On the other hand, without care, that same 25 year old can expect to live less than two years.

When it comes to HIV/AIDS, an individual's location should not be the determining factor in his or her longevity. But in Selma -- and across rural Alabama and the rural South -- that's all too often the case.

Alabama is disproportionately burdened with HIV infections (over 17,000 state residents are living with HIV/AIDS), and further stressed by a lack of qualified HIV experts. Of the 31,000-plus licensed physicians in the state, only 55 are infectious disease specialists and only four are credentialed HIV Specialists with the American Academy of HIV Medicine (AAHIVM). That's one specialist per 81,402 Alabamians.

With roughly 4,450 people living with HIV per AAHIVM provider in Alabama, the focus must be on amplifying the existing treatment resources in order to provide high quality care to as many patients as possible.

This is where Montgomery-based Medical AIDS Outreach (MAO) of Alabama comes in. In 2011, MAO -- which employs one of Alabama's 55 Infectious Disease doctors, along with two of the state's four AAHIVM physicians, and one of the state's two AAHIVM pharmacists -- received an initial $235,000 Social Innovation Fund-supported Access to Care grant from AIDS United. MAO matched this grant dollar for dollar, resulting in $470,000 to develop and launch its eHealth program, which uses technology to reach, educate, treat and extend the life expectancy of its patients living with HIV/AIDS, roughly 150 of whom live in Selma.

The technology, consisting of HD video, Bluetooth stethoscope, and digital ENT/dermascope, allows physicians to videoconference with patients who cannot travel to an HIV treatment center. Through these tools, doctors are able to examine and evaluate critical diagnostic information such as heart, lung, and abdominal sounds, flushed skin, lesions or thrush -- all are important in determining an appropriate course of treatment.

Before implementing the eHealth program, MAO staff members made the 100-mile round-trip drive from Montgomery to Selma once a week, hauling medical files and a treatment team of a nurse, phlebotomist, and doctor. The team would stay in Selma for the afternoon, treating those local HIV patients who were able to schedule an appointment in the middle of the workday. However, as noted above, access and efficiency are critical components to successful HIV treatment. Both the limited availability and the amount of lost time spent in transit needed to change.

With support from AIDS United and its local funding partners, MAO has leveraged its resources by way of technology, streamlining its operations and expanding its capacity to provide life-saving care to HIV patients in Selma and beyond. Now a year into the program, MAO is able to offer more frequent opportunities for rural patients to be seen and treated. High-speed broadband cables and high-definition monitors bridge the gap between patients in Selma and those doctors and pharmacists who are best qualified to treat them.

This approach has been revolutionary for people living with HIV/AIDS in rural Alabama -- continuing to positively transform the relationship between doctor and patient. Change is not easy, but the change taking place in Selma -- and across Alabama -- is building momentum for much broader systematic change in the southern communities hit hardest by the HIV/AIDS epidemic.