Medical Advocacy and Outreach of Alabama (MAO), formerly Medical AIDS Outreach and Montgomery AIDS Outreach, recognized a number of rurality-driven barriers related to accessing care in the Deep South. The combination of rurality, health professional shortages, stigma, and poverty compounded by the increasing number of HIV diagnoses in Alabama posed a significant challenge in reaching people living with HIV/AIDS (PLWH/A) in rural Alabama.
Founded in 1987, MAO began as an all-volunteer force and transitioned to a full service medical facility for HIV/AIDS clients in 1996. Since that time, MAO clinic staff have traveled to rural areas throughout Alabama where HIV rates are highest to provide care where it is needed. However, the travel burden on the providers took time away from patients as the staff spent nearly half of their day traveling to and from rural clinic locations.
In 2011, faced with the confluence of rurality and poverty driven barriers and an ever increasing diagnosis rate, MAO sought a new means of providing care for rural clients. Realizing that the barriers to care were preventing rural Alabamians from accessing the care they needed, MAO looked for ways to break down barriers in order to bring quality care to underserved rural populations.
Thanks to a matching grant from AIDS United in 2011, MAO was able to establish Alabama’s first telemedicine network serving PLWH/A in rural Alabama. Using high-speed internet connections, Bluetooth peripherals, high definition audio-video equipment, and partnerships with rural social services organizations, MAO created a network to bring primary HIV care to rural Alabama without the need for travel.
Rural Medicine for Tomorrow
MAO’s first telemedicine clinic was established in Selma, Alabama in 2011. Telemedicine technology allowed for a provider in Montgomery Alabama to treat a patient in Selma Alabama in real time video conference with the help of an on-site nurse to facilitate the patient-end of the encounter. Using high definition cameras and video screens that meet privacy requirements of the Health Insurance Portability and Accountability Act, 128-bit encryption, high speed internet and Bluetooth medical technology, clinicians in urban settings can treat patients in rural clinics, providing real-time, direct to patient HIV primary care from a distance. Growing from one patient clinic and one provider location, MAO expanded its telemedicine network to cover 12 counties throughout rural Alabama. Today MAO operates a telemedicine network consisting of two provider locations and 10 rural patient clinics.
HIV Treatment and Stigma
By branding the telemedicine patient clinics as Alabama eHealth, MAO removed the stigma associated with HIV-specific clinics. Patients no longer risk exposing their HIV status by entering a stigmatized clinic location – Alabama eHealth is a neutral label, and clinics have been placed in partnering agencies that serve various specialties. By reducing the stigma, placing care in more convenient locations to patients, and offering ancillary services like mental health counseling, social services, and pharmacy consultations through telemedicine, MAO has gained national attention for their phenomenal retention rate for HIV patients, with greater than 90% of patients consistently retained in care.
The American Academy of HIV Medicine and the Institute for Technology in Healthcare awarded the Alabama eHealth project for its innovative use of technology in the HIV care setting. Additionally, the White House’s national HIV strategy highlighted the Alabama eHealth model as a viable and cost-effective means of reaching rural HIV patients. Most recently, the governor of Alabama, recognizing the state’s egregiously disproportionate number of poor health outcomes in rural counties, turned to MAO for advice on addressing health disparities, nominating MAO’s CEO Michael Murphree to the state’s healthcare task force. Murphree has also been invited to participate in three rural health conferences at the White House where he advocates for policies to bolster rural healthcare capabilities.
MAO has plans to add four additional rural clinic locations in 2016. Having already expanded the range of services offered by telemedicine, MAO will expand services in 2016 to include diabetes management and substance abuse treatment and counseling. Focusing on the Black Belt counties in Alabama, MAO anticipates an expansion that will provide for some of the poorest areas in the nation. MAO believes that it is incumbent upon our organization, and the nation’s healthcare infrastructure, to dissolve the barriers to care presented by: rurality, poverty, endemic stigma, profound lack of resources and the balance of plagues that befall our most vulnerable neighbors. We believe that technology is an elegant tool capable of lowering these barriers.