HIV/AIDS and the Barrier,Transportation All Around the World

By Rob Banaszak on July 30, 2012 in 2012 International AIDS Conference

By Tommy Jones,
Access Coordinator
Hertford County Public Health Authority

One of my primary responsibilities as an Access Coordinator is to try to make contact with patients that have dropped out of care and get them back into the care. Many of the counties that these patients reside in are in a very rural area. I have found that patients often fall out of care not because they don’t want to take care of themselves or take their medicine but more often than not, have difficulty with obtaining transportation to the sites to get their care. Sometimes the issue of transportation can be resolved once they are in touch with their medical case managers but often it continues to be a barrier. The rural area of Northeastern North Carolina is not like many areas that have a wide variety of transportation services. The transportation system that services clients from our area is nearly non-existent. It consists of a few vans that pick up large groups of people with very long waiting times and this even changes depending on what county they live in. Some counties don’t even have this service at all.

I don’t have a solution to this barrier but believe until this barrier is removed or reduced we will always have people that will drop out of care regardless of the part of the world clients live in. To add to the problem in the area we serve the nearest medical provider that specializes in HIV care is on average 2-3 hours away from the 11 county service area we serve. The way we are attempting to address the issue in the Northeastern North Carolina Region 9 Network of Care is with the use of a mobile unit to bring care closer to the clients. We have 5 mobile clinics and 1 fixed site clinic that clients can come to for their lab/clinic visits. By doing this we are able to cut down travel time for clients as much as 1-2 hours in many cases; however, this doesn’t totally solve the transportation issue. We still have clients that can’t even get the needed 30-50 minutes’ drive to get to the care appointments now. Our next efforts were to attempt to resolve this issue so we worked with a local agency that was new to providing transportation to provide transportation for these clients. This has been a great help but even doing this we still face struggles since we have to be able to provide the transportation service a 72 hours advanced notice. In many cases clients need care appointments in less than 72 hour so we are still facing transportation issues.
Looking towards the future we must think about how we will sustain the program. As time moves forward the mobile unit is getting older and the client case load is increasing. We are going to eventually be faced with mobile unit break downs, an increased number of clients in the program and an increase need for transportation. The current program funding can only support so many costs. We are thinking now about plan B, C. Ideas have been tossed around about Telemedicine as a way to serve some of the more stable clients in an effort to increase the number of clients we can serve with the funding we have. At this point this has just been discussion. Another thought is to set up satellite clinics in each county where clients can come at any time to get blood work done, meet with medical case managers and providers. The goal is to work with current agencies that will share space (possibly local health departments) to prevent having the overhead cost. The satellite clinics could be staffed with volunteers to help current program staff. The volunteers could be people that are living with HIV/AIDS and have been train to operate in these areas. All data collected would be transmitted to the H.C.P.H.A. which would be entered into CareWare. This would not only eliminate the expense of operating the mobile unit but it would put people living with HIV/AIDS back into the work force in these satellite clinics. This would not only increase assess for our patients but could potentially add services to the clients in the community. The Hertford County Public Health Authority has been in the fight a long time and has learned a lot along the way but are always open to change in an effort to serve the clients. In saying this we realize we must change our methods of operating to accomplish this. We have to continuously try to think outside the box to serve the clients in our rural area. We would look forward to any advice you may have or lessons learned in your endeavors that you may be willing to share.

Working as an Access Coordinator and carefully watching my clients, I have come to realize that the more the clients know about their CD4 count and their viral load seems to improve their self-esteem. That improved self-esteem makes them more responsible for taking their meds on time and how detrimental it can be when they don’t take your meds on time. We really have to do something about the transportation issue around the world. If we don’t we will never and I mean never stop the spread of HIV/AIDS. I would like to thank AIDS Unity for given me opportunity to attend this conference and I look forward to answering any questions that you may have.

Tommy Jones Access Coordinator

Hertford County Public Health Authority

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