www.AIDSVu.org

Seeing Solutions: Telemedicine as a Means to Dissolve the Barriers to Care Faced by

Consumers Living with HIV/AIDS Throughout Rural Alabama

Sandra PercivalProgram Director, Telemedicine

www.AIDSVu.org

Medical AIDS Outreach of Alabama (MAO)

Mission Statement: Medical AIDS Outreach of Alabama provides community prevention education, quality services and compassionate care to those infected and/or affected by HIV/AIDS. Services provided include: social services, medical treatment, medication assistance, pharmacist consultations, mental health counseling, patient education, prevention education, HIV testing, food bank services and interpretation services for Spanish- language and hearing impaired communities.

www.AIDSVu.org

• Increasing number of HIV diagnoses

• Poverty

• Health Professional Shortage Areas

• Stigma

Barriers to Care

www.AIDSVu.org

Rates of Individuals Living with an HIV Diagnosis in Alabama

• At the end of 2012, a total of 11,936 individuals were known to be living with HIV in Alabama. Of these individuals, 4,869 (41%) had progressed to the AIDS diagnosis.

• It is estimated that an additional 2,000 to 4,000 individuals are living with HIV but unaware of their status.

*HIV diagnosis per 100,000 population

www.AIDSVu.org

Recent Trends: 2008 to 2012

The number of people living with HIV/AIDS in Alabama has increased 21% from 2008 to 2012.

www.AIDSVu.org

Demographics

Although only 26% of the state’s population is Black/African-American, 68% of newly diagnosed HIV cases and 65% of all persons living with HIV in Alabama were African-American/Black in 2012

www.AIDSVu.org

Poverty Rates in Alabama

Out of Alabama’s 67 counties…• 46 counties have poverty rates that are

higher than the national average.

• 23 counties have poverty rates above 20%.

• 5 counties have poverty rates above 30%.

• Wilcox County has the highest poverty rate in Alabama, with 38.5% of its population living below the poverty line.

• According to the US Census Bureau, the average household income in Alabama is less than 200% of the federal poverty definition.

• Fully 17.1% (or roughly 1 out of every 6 of Alabama’s 4.8M residents) live below the federal poverty line

Choctaw

Houston

Montgomery

Autauga

Lauderdale Limestone Madison Jackson

Colbert

Franklin

LawrenceMorgan

Marshall

DeKalb

MarionWinston

Cullman

Blount

Etowah

Cherokee

Calhoun

Cleburne

Lamar

Fayette Walker

Jefferson

St. Clair

Pickens Tuscaloosa Shelby

Talladega

Clay Randolph

Sumter

GreeneHale

Perry

BibbChilton

Coosa

Tallapoosa Chambers

Elmore

Macon

Lee

RussellMarengo

Dallas

Lowndes Bullock

Barbour

HenryDale

Geneva

Coffee

Pike Cren- shaw

Wilcox

Clarke

WashingtonConecuh

CovingtonEscambia

Baldwin

Mobile

Butler

Monroe

<10%10-14.9%15-19.9%20-29.9%>30%

Choctaw

www.AIDSVu.org

Health Professional Shortage Areas (HPSA)

Montgomery

Autauga

Lauderdale Limestone Madison Jackson

Colbert

Franklin

LawrenceMorgan

Marshall

DeKalb

MarionWinston

Cullman

Blount

Etowah

Cherokee

Calhoun

Cleburne

Lamar

Fayette Walker

Jefferson

St. Clair

Pickens Tuscaloosa Shelby

Talladega

ClayRandolph

Sumter

GreeneHale

Perry

BibbChilton

Coosa Tallapoosa Chambers

Elmore

Macon

Lee

Russell

Choctaw

Marengo

Dallas

Lowndes Bullock

Barbour

HenryDale

HoustonGeneva

Coffee

Pike Cren- shaw

Wilcox

Clarke

WashingtonConecuh

CovingtonEscambia

Baldwin

Mobile

Butler

Monroe

Contains areas that are designated as HPSAs

Entire County is designated as a HPSA

• 62 of Alabama’s 67 counties are, either partially or whole, Health Professional Shortage Areas.

• For a general population of 4.8M there are only 57 ID Docs (most of whom are tasked to institutions) and approximately 5 AAHIVM credentialed physicians (voluntary).

www.AIDSVu.org

What is Telemedicine?

• Telemedicine is a video chat environment between a doctor and a patient

• High definition camera and video screen with 1080p capability

• Bluetooth peripheral equipment

• 100% secure: telemedicine uses 128 bit encryption – twice the level of encryption used by the DOD

• Transcends almost all of the barriers most PLWH/A face in accessing care

Photo courtesy of David Kohn, Washington Post

www.AIDSVu.org

Telemedicine - Beginning

MAO created “spoke” telemedicine clinics in Selma, Sipsey, and Florence, Alabama, with corresponding “hubs" in Montgomery, Tuscaloosa, and Huntsville, Alabama.

Using encrypted, high-speed data connections, spoke-site RN support, and high-definition video/diagnostic tools, our interdisciplinary hub-site providers are able to hold real-time encounters more frequently and more consistently, increasing both access to care and the fullness of care available to our rural HIV patients.

www.AIDSVu.org

Telemedicine - Today

Linking the hubs and beyond……

MAO expansion to Troy, Clayton and the Wiregrass area with a hub in Dothan

www.AIDSVu.org

Outcomes

Results of our work so far:

• Retention rate of 92% per survey data•Positive response by consumers to the use of Telemedicine in their care• At their initial telemedicine appointment, patients are asked to rate their health

• 74.49% of patients rated their health as excellent, very good, or good at that first interview.

• After six months of telemedicine care, that number rose to 81.82% • After twelve months in the program, all 100% of telemed patients

rated their health as excellent, very good, or good!

www.AIDSVu.org

Contact Information

Sandra PercivalProgram Director, Telemedicine and Distance Learning Initiatives

MAO of Alabama, Inc.2900 McGehee Road

Montgomery Alabama 36111334-280-3349 or 334-386-0857

Email: spercival@maoi.org