Will rutland broadband & telehealth summit

Seeing Solutions: Dissolving, Through Telemedicine, the Barriers to Care Faced By

Consumers Living with HIV/AIDS Throughout Rural Alabama

Will RutlandWill RutlandBroadband & Telehealth Summit 2012Broadband & Telehealth Summit 2012

October 18, 2012October 18, 2012

www.AIDSVu.org

Rates of Individuals Living with an HIV Rates of Individuals Living with an HIV Diagnosis in AlabamaDiagnosis in Alabama

• At the end of 2011, a total of 11,348 individuals were known to be living with HIV in Alabama. Of these individuals, 4,452 (39%) have progressed to AIDS.

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

• 2 out of every 5 Alabamians, living with HIV/AIDS, reside in ultra-rural communities, far removed from adequate treatment resources.

*HIV diagnosis per 100,000 population

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Recent Trends: 2007 to 2011Recent Trends: 2007 to 2011

3702 4003 4452 43184149

68965328 6332 58224871

Total=8,573

Total=10,650Total=11,348

Total=9,971Total=9,331

Source: Alabama Department of Public Health, Division of HIV/AIDS Prevention and Control

The number of people living with HIV/AIDS in Alabama has increased 32% from 2007 to 2011.

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DemographicsDemographics

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Racial DisparitiesRacial Disparities

*HIV diagnosis per 100,000 population

The rate of black males living with HIV in Alabama is 5.0 times that of white males.

The rate of black females living with HIV in Alabama is 9.5 times that of white females.

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Poverty Rates in AlabamaPoverty 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

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Health Professional Shortage Areas (HPSA)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 only 4 AAHIVM credentialed providers (that equates to roughly one expert per 80,000 Alabamians).

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Medical AIDS Outreach of Alabama (MAO)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 (Spanish to English) and hearing impaired.

www.AIDSVu.org

Telemedicine - TodayTelemedicine - Today

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

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

www.AIDSVu.org

Telemedicine - TomorrowTelemedicine - Tomorrow

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

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

www.AIDSVu.org

Telehealth ServicesTelehealth Services

• Consultations• Office or other outpatient visits• Individual psychotherapy• Pharmacologic management• Psychiatric diagnostic interview examination• End-Stage Renal Disease (ESRD)-related services• Individual medical nutrition therapy• Neurobehavioral status examination• Follow-up inpatient telehealth consultations

Currently, the list of Medicare telehealth services include: