1. Seeing Solutions: Telemedicine as a Means
to Dissolve the Barriers to Care Faced by
Consumers Living with HIV/AIDS Throughout
Rural Alabama
Sandra Percival
Program Director, Telemedicine
www.AIDSVu.org

2. 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 for Spanish- language and hearing impaired
communities.
www.AIDSVu.org

3. Barriers to Care
•
Increasing number of HIV
diagnoses
•
Poverty
•
Health Professional Shortage Areas
•
Stigma
www.AIDSVu.org

4. Rates of Individuals Living with an HIV
Diagnosis in Alabama
• At the end of 2012, a total of 11,936
individuals were known to be living with
HIV in Alabama. Of these individuals,
4,869 (41%) had progressed to the AIDS
diagnosis.
*HIV diagnosis
per 100,000
population
• It is estimated that an additional 2,000 to
4,000 individuals are living with HIV but
unaware of their status.
www.AIDSVu.org

5. Recent Trends: 2008 to 2012
The number of
people living
with HIV/AIDS
in Alabama has
increased 21%
from 2008 to
2012.
www.AIDSVu.org

6. Demographics
Although only 26% of the state’s population is Black/African-American, 68% of newly diagnosed HIV
cases and 65% of all persons living with HIV in Alabama were African-American/Black in 2012
www.AIDSVu.org

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

8. Health Professional Shortage Areas (HPSA)
Lauderdale
Limestone
Madison
• 62 of Alabama’s 67
counties are, either
partially or whole,
Health Professional
Shortage Areas.
Jackson
Colbert
Lawrence
Franklin
DeKalb
Morgan
Marshall
Cullman
Marion
Winston
Cherokee
Etowah
Blount
Lamar
Fayette
Walker
Calhoun
St. Clair
Cleburne
Jefferson
Talladega
Randolph
Tuscaloosa
Pickens
Shelby
Bibb
Chilton
Greene
Clay
Coosa
Tallapoosa
Chambers
Hale
Perry
Elmore
Sumter
Lee
Autauga
Macon
Dallas
Montgomery
Russell
Marengo
Bullock
Lowndes
Wilcox
Choctaw
Barbour
Clarke
Butler
Monroe
Crenshaw
Pike
Henry
Washington
Escambia
Baldwin
Mobile
Dale
Conecuh
Coffee
Covington
Geneva
• For a general population
of 4.8M there are only 57
ID Docs (most of whom
are tasked to institutions)
and approximately 5
AAHIVM credentialed
physicians (voluntary).
Houston
Contains areas that are designated as HPSAs
Entire County is designated as a HPSA
www.AIDSVu.org

9. What is Telemedicine?
•Telemedicine is a video chat
environment between a doctor
and a patient
•High definition camera and
video screen with 1080p
capability
•Bluetooth peripheral
equipment
•100% secure: telemedicine
uses 128 bit encryption – twice
the level of encryption used by
the DOD
•Transcends almost all of the
barriers most PLWH/A face in
accessing care
Photo courtesy of David Kohn, Washington Post
www.AIDSVu.org

10. Telemedicine - Beginning
MAO created “spoke” telemedicine 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. Telemedicine - Today
Linking the hubs and beyond……
MAO expansion to Troy, Clayton
and the Wiregrass area with a
hub in Dothan
www.AIDSVu.org

12. Outcomes
Results of our work so far:
• Retention rate of 92% per survey data
•Positive response by consumers to the use of Telemedicine in their care
• At their initial telemedicine appointment, patients are asked to rate their
health
• 74.49% of patients rated their health as excellent, very good, or good
at that first interview.
• After six months of telemedicine care, that number rose to 81.82%
• After twelve months in the program, all 100% of telemed patients
rated their health as excellent, very good, or good!
www.AIDSVu.org

13. Contact Information
Sandra Percival
Program Director, Telemedicine and Distance Learning Initiatives
MAO of Alabama, Inc.
2900 McGehee Road
Montgomery Alabama 36111
334-280-3349 or 334-386-0857
Email: spercival@maoi.org
www.AIDSVu.org