1. Seeing Solutions: Dissolving, Through
Telemedicine, the Barriers to Care Faced By
Consumers Living with HIV/AIDS Throughout
Rural Alabama
Will Rutland
Broadband & Telehealth Summit 2012
October 18, 2012

2. Rates of Individuals Living with an HIV
Diagnosis 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
*HIV diagnosis communities, far removed from adequate
per 100,000
population
treatment resources.
www.AIDSVu.org

3. Recent Trends: 2007 to 2011
Total=11,348
Total=10,650
Total=9,971
Total=8,573
Total=9,331 The number of
people living
with HIV/AIDS
4871 5328 5822 6332 6896
in Alabama has
increased 32%
3702 4003 4149 4318 4452
from 2007 to
2011.
Source: Alabama Department of Public Health, Division of HIV/AIDS Prevention and Control
www.AIDSVu.org

4. Demographics
www.AIDSVu.org

5. Racial Disparities
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.
*HIV diagnosis per
100,000 population
www.AIDSVu.org

6. Poverty Rates in Alabama
Lauderdale Limestone Madison
Out of Alabama’s 67 counties…
Jackson
Colbert
Franklin
Lawrence
Morgan
DeKalb • 46 counties have poverty rates that are
Marshall
higher than the national average.
Marion Cullman Cherokee
Winston
Etowah
Blount • 23 counties have poverty rates above 20%.
Walker Calhoun
Lamar Fayette
St. Clair
Jefferson
Cleburne
• 5 counties have poverty rates above 30%.
Talladega
Tuscaloosa Randolph
Pickens Shelby Clay
•Wilcox County has the highest poverty rate
Greene
Bibb
Chilton
Coosa
Tallapoosa Chambers in Alabama, with 38.5% of its population
Hale
Perry
living below the poverty line.
Elmore
Sumter Lee
Autauga
Dallas Montgomery
Macon
• According to the US Census Bureau, the
Russell
Choctaw
Marengo
Bullock
average household income in Alabama is
Lowndes
Choctaw Wilcox
less than 200% of the federal poverty
Barbour
Clarke
Cren-
Pike definition.
Butler shaw
Monroe
Henry
Washington
Conecuh
Coffee
Dale
•Fully 17.1% (or roughly 1 out of every 6 of
Escambia
Covington
Houston
Alabama’s 4.8M residents) live below the
Geneva
Baldwin
federal poverty line
Mobile
<10%
10-14.9%
15-19.9%
20-29.9%
>30%
www.AIDSVu.org

7. Health Professional Shortage Areas (HPSA)
• 62 of Alabama’s 67
Lauderdale Limestone Madison
Jackson
Colbert
Franklin
Lawrence
Morgan
DeKalb counties are, either
Marion
Winston
Cullman
Marshall
Etowah
Cherokee partially or whole, Health
Blount
Professional Shortage
Walker Calhoun
Areas.
Lamar Fayette
St. Clair
Cleburne
Jefferson
Talladega
Randolph
Pickens Tuscaloosa Shelby Clay
Bibb
• For a general population
of 4.8M there are only 57
Greene Chilton Chambers
Coosa Tallapoosa
Hale
Perry
Elmore
Sumter Autauga
Macon
Lee
ID Docs (most of whom
Marengo
Dallas
Lowndes
Montgomery
Bullock
Russell
are tasked to institutions)
Choctaw Wilcox
Barbour
and only 4 AAHIVM
credentialed providers
Clarke Butler Cren- Pike
shaw
Monroe
Henry
Washington
Conecuh
Coffee
Dale
(that equates to roughly
one expert per 80,000
Covington
Escambia Houston
Baldwin Geneva
Mobile
Contains areas that are designated as HPSAs Alabamians).
Entire County is designated as a HPSA
www.AIDSVu.org

8. 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

9. Telemedicine - Today
MAO has created “spoke” telemedical
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

10. Telemedicine - Tomorrow
MAO has created “spoke” telemedical
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

11. Telehealth Services
Currently, the list of Medicare telehealth services include:
• 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
www.AIDSVu.org