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Rural residence and adoption of a novel HIV therapy in a national, equal-access healthcare system

  • Author(s): Ohl, M
  • Lund, B
  • Belperio, PS
  • Goetz, MB
  • Rimland, D
  • Richardson, K
  • Justice, A
  • Perencevich, E
  • Vaughan-Sarrazin, M
  • et al.

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Rural persons with HIV face barriers to care that may influence adoption of advances in therapy. We performed a retrospective cohort study to determine rural-urban variation in adoption of raltegravir - the first HIV integrase inhibitor - in national Veterans Afffairs (VA) healthcare. There were 1,222 veterans with clinical indication for raltegravir therapy at time of its FDA approval in October 2007, of whom 223 (19.1%) resided in rural areas. Urban persons were more likely than rural to initiate raltegravir within 180 days (17.3% vs. 11.2%, P = 0.02) and 360 days (27.5% vs. 19.7%, P = 0.02), but this gap narrowed slightly at 720 days (36.3% vs. 31.8%, P = 0.19). In multivariable analysis adjusting for patient characteristics, urban residence predicted raltegravir adoption within 180 days (odds ratio 1.72, 95% CI 1.09-2.70) and 360 days (OR 1.63, 95% CI 1.13-2.34), but not 720 days (OR 1.26, 95% CI 0.84-1.87). Efforts are needed to reduce geographic variation in adoption of advances in HIV therapy. © 2011 Springer Science+Business Media, LLC.

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