Background:  Geographic location can determine access to HIV/AIDS health care services. Clinical outcomes and healthcare utilization were evaluated in rural and urban patients seen at high volume United States HIV care sites.

Methods:  Zip codes for 17,312 HIV patients followed in 2005 at 5 HIV research network sites (1 east, 2 south, 2 west) were categorized via University of Washington rural health categorization schema as rural (<10,000) and urban (>100,000). Clinical and demographic characteristics, inpatient and outpatient utilization, opportunistic illness admissions rates categorized from International Classification of Diseases (ICD) -9 codes, HAART, and opportunistic infection prophylaxis usage and virologic suppression were compared among urban and rural patients, using X² tests for categorical variables, t-tests for means, and logistic regression for utilization of HAART.

Results:  Rural (n = 170) HIV patients were less likely to be black (22% vs 40%, p <0.001) or Hispanic (11% vs 20%, p <0.001) than urban (n = 8416) patients. Rural patients did not differ from urban patients by age, gender, hepatitis C virus (HCV) status, HIV risk factors, mean CD4 or HIV RNA levels, viral suppression, or usage of opportunistic infection prophylaxis. Overall, in multivariate analysis, rural patients were more likely than urban patients to be on HAART (AOR 1.25, 95%CI 1.04 to 1.51). In multivariate analysis, among patients with CD4<350, rural patients were also more likely to be on HAART (OR 1.24, 95%CI 0.92 to 1.67) than urban patients. However, blacks (OR 0.40, 0.34 to 0.46) and injection drug users (IDU) (OR 0.61, 0.51 to 0.73) were less likely to be on HAART than their counterparts.  Overall, urban patients had more outpatient visits (5.24 vs 3.95/person/year, p <0.001) and inpatient visits than rural patients (27 vs 17/100 person-years, p = 0.06). These trends remained when evaluating only patients on HAART:  outpatient 5.82 vs 4.02/person/year (p <0.001) and inpatient 27 vs 17/100 person-years (p = 0.09). Hospitalization rates for opportunistic infections did not differ between rural and urban patients.

Conclusions:  Few demographic and clinical differences were noted between rural and urban HIV patients, except for the increase in black and Hispanic patients in urban areas.  Although rural patients had fewer outpatient and inpatient visits, there were no differences in admission rates for opportunistic infections among rural and urban patients.  Rural HIV patients can receive high quality HIV care; however areas for improvement in rural care include access to HAART among minorities and IDU.