Need: Patients who identify as LGBTQ+ in rural settings may face barriers to receiving appropriate care, including a knowledge gap among healthcare providers regarding HIV prevention, hormone replacement therapy, and other types of care.
Intervention: A partnership between a Critical Access Hospital, statewide residency program, nonprofit organization and other regional entities provides training, virtual consultations, and resources to rural providers across Idaho.
Results: Physicians experienced in gender-affirming care have performed virtual consultations for rural physicians and patients around the state, and the number of local providers trained in PrEP management has doubled.
Patients who identify as LGBTQ+ in rural communities may
face barriers to receiving needed care, including
stigmatization and a knowledge gap among rural primary
care providers when it comes to HIV prevention, as well
as hormone replacement therapy and other forms of
gender-affirming care. In Idaho, the late-stage diagnosis
rate for HIV is approximately 40%, four times higher than
in neighboring states.
Rural physicians with patients who require pre-exposure
prophylaxis (PrEP) treatment for HIV prevention, hormone
replacement therapy, or other forms of gender-affirming
care may not feel sufficiently knowledgeable about these
types of care to provide these services themselves. In
such cases, rural doctors can request a virtual
consultation with another Idaho-based physician with
expertise in providing care and teaching rural residents
these skills. Consultations take place during the
patient's appointment and allow the patient to receive
appropriate care while remaining under the care of their
primary care doctor and without needing to travel.
Consultations may be one-time calls to establish a care
plan, or ongoing calls to co-manage a patient's care
long-term. This service is available to any rural
physician in the state.
The PiICN Project has additionally held trainings for
rural providers in PrEP management and in the principles
of the Family
Acceptance Project, a national initiative to support
and prevent health risks for LGBTQ+ children.
To share best practices and lessons learned during the
implementation of PiICN, project leaders published the
Pride in Idaho Care Neighborhoods Roadmap. The PiICN
Project also published a
Resource Library for individuals, health care
providers and systems, and non-clinical partners with
resources "to support communities across the state and
country in developing more inclusive, safe, and
culturally appropriate care environments for LGBTQ+
Virtual consultations are now available to any rural physician in Idaho. The PiICN Project is working directly with three Critical Access Hospitals around the state to implement the model, and continues to look for opportunities to work with health systems in other Idaho communities. Five physicians have utilized virtual consultations, with another 20 expected to receive training within the next year.
The PiICN Project has trained more than 80 providers and staff in the tenets of the Family Acceptance Project and doubled the number of local providers trained in PrEP management.
The first meeting of PiICN consortium members generated
interest from community partners, but momentum dwindled
in the following months due to a lack of concrete data to
identify areas of greatest need. To give the consortium a
clearer sense of direction and launching point, project
leaders conducted an assessment of need within the local
community several months after the group's initial
meeting, renewing the project's momentum.
The PiICN Project was initially designed around in-person
meetings and trainings, but COVID-19 precautions forced
project leaders to pivot to virtual sessions and
gatherings. Remote meetings and trainings may be more
convenient for rural consortium members and trainees but
are not recommended by project leaders, who say in-person
meetings and trainings foster more personalized and
For those interested in creating similar programs, some
best practices recommended by PiICN Project leaders
Start with data to clearly establish need and project
Begin conversations with healthcare providers with a
basic discussion of language and its importance in
treating LGBTQ+ patients.
Make sure entire healthcare provider teams – not only
one "provider champion" – are trained in caring for
Have local presenters host trainings when possible.
Please contact the models and innovations contact directly for the most complete and current information
about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The
programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural
community should consider whether a particular project or approach is a good match for their community’s
needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep
in mind that changes to the program design may impact results.