Medical Advocacy & Outreach's Telehealth Services

Evidence-level

Effective (About evidence-level criteria)

Description

Before 2011, the barriers that make it difficult for patients living with HIV/AIDS (PLWH/A) to receive medical care in rural Alabama were significant. Transportation, poverty, stigma, and the shortage of medical providers credentialed in HIV care prevented patients from receiving timely face-to-face medical help.

Medical Advocacy & Outreach (MAO) of Alabama is a non-profit, community-based organization that was established in 1987 to address the rising rate of PLWH/As in rural Alabama. In 2011, MAO created the state's first telemedicine network that offers rural medical providers a cost-effective way to connect PLWH/As with HIV/AIDS medical care.

Alabama eHealth connects patients in rural areas to primary care, pharmacist consultations, mental health counseling, and social services located at MAO hub sites. Using high-speed internet connections, Bluetooth peripherals, and high definition audio-video equipment eliminates the need for travel and provides quick medical access for PLWH/As.

Alabama eHealth satellite clinics are located in 10 rural towns surrounding hub sites in Montgomery, Dothan, and Atmore. MAO also partners with clinics in the cities of Sipsey, Florence, Tuscaloosa, and Huntsville to provide support for telehealth efforts in their surrounding rural areas. Alabama eHealth is actively operating out of 12 Alabama counties with services made available to patients in 28 counties. MAO has future plans to continue the expansion of Alabama eHealth to additional rural Alabama counties as connectivity becomes available.

MAO's Telehealth Resource Center facilitates Alabama eHealth and assists other healthcare agencies in duplicating this model and other telehealth initiatives in Alabama and across state lines (North and South Carolina, New Mexico, Hawaii, and New York). The Center offers training to medical and administrative staff in the operation of the telehealth equipment/peripherals and provides additional assistance, including:

• Readiness evaluations
• Action planning
• Network connectivity
• Best practices/lessons learned
• Funding opportunities
• Equipment negotiations
• Purchasing
• Installation services
• Licensing and legal requirements
• Equipment familiarization
• Follow-up conversations

MAO was originally supported by a matching grant from AIDS United and the Corporation for National and Community Service (now AmeriCorps) Social Innovation Fund. They are now supported with help from the following foundations, grants, and private donors:

• Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program and the AIDS Education and Training Centers Program
• Elton John AIDS Foundation
• M•A•C AIDS Fund
• AIDS Alabama
• Southern AIDS Coalition
• CDC Telehealth Expansion Grant administered by the Alabama Department of Public Health

Services offered

Through the Alabama eHealth network, MAO connects patients to the following services:

• HIV education and testing
• Community prevention education
• Case management and social services
• Hepatitis C care for mono-infected or co-infected patients
• Mental/behavioral health and substance abuse counseling
• Pre-exposure prophylaxis (PrEP) care
• In-house pharmacy/consultation/medication adherence
• Onsite dental clinic
• Maternity and infant services
• Nutritional support and subsidies
• Interpreter services

MAO also offers education to medical providers in rural areas and support to rural residents in the following ways:

• MAO's Department of Capacity Building works to build a healthier Deep South through collaborative learning with individuals, families, organizations, communities, and decision makers.
• The MAO Learning Center supports professionals and clients through practice-based training programs focused on health topics, including HIV/STIs, cultural humility, and civic engagement.
• In partnership with Vanderbilt University's Southeast AIDS Education and Training Center, the Learning Center houses the Alabama AETC program, facilitating comprehensive professional HIV training to healthcare professionals at all levels.
• Community educators and outreach staff work to increase quality of life for all Alabamians, with a particular commitment to rural residents.
• The Wiregrass Breaking Barriers Summit is an annual rural health and wellness event attended by healthcare professionals.

Results

MAO has provided patients living with HIV improved access to care, travel costs, and quality of care through their telehealth services. An evaluation of Alabama eHealth led by Johns Hopkins Bloomberg School of Public Health found the following positive outcomes of the MAO's Alabama eHealth service:

• 100% of HIV-positive clients are linked to care within 30 days of their appointment
• 97% of clients had a current prescription for antiretroviral therapy (drug that suppress the HIV virus and stops its progression)
• 93% of Alabama eHealth clients were virally suppressed
• 96% of clients in the program are retained in HIV medical care
• For every dollar spent on patients through this program, MAO saved $1.44 in future medical costs for the patient
• Retention care, no-show rates, and viral retention rates have improved at a higher rate than in-person care, especially for younger and older patient populations

Jain et al. (2018) Extending access to care across the rural US south: Preliminary results from the Alabama eHealth programme. Journal of Telemedicine and Telecare. Article Abstract

MAO has received the following honors:

• Named winner of the 2015 American Academy of HIV Medicine Institute for Technology in Health Care HIV Practice award.
• White House national HIV strategy highlighted the Alabama eHealth model as a viable and cost-effective means of reaching rural PLWH/As.
• In 2015, the Alabama governor nominated MAO's CEO, Michael Murphree, to the state's healthcare task force. The White House has also extended an invitation for Murphree to advocate for policies and bolster rural healthcare capabilities for those living with HIV.
• Alabama Partnership for TeleHealth (APT), a charitable nonprofit organization, in partnership with the Southeastern TeleHealth Resource Center recognized MAO with the "Telehealth Champion of the Year" in 2016.

Read more on MAO and their telehealth initiatives in the news:

• HIV Advocacy Group Pioneers Telehealth Model in Rural Alabama, Montgomery Advertiser, 2019
• Fighting AIDS in the Deep South: Glimmers of Hope, PEW, 2017
• Rural HIV patients linked to medical care (video included), Montgomery Advertiser, 2014
• Medical AIDS Outreach reaching patients in rural Alabama through telemedicine, AL.com, 2014

Other features:

• MAO is featured in RHIhub's Rural HIV/AIDS Prevention and Treatment Toolkit.
• The Alabama eHealth program is featured in AIDS United's Making Connections: A Guide to Starting a Rural Health Care Telemedicine Program
• For better understanding of how MAO successfully implements telehealth services across two-thirds of Alabama, watch Dr. Bhat's interview on this Improving Access to HIV/AIDS Care: Telemedicine video (starting at 19:55).

Challenges

Finding broadband connections has been one of MAO's greatest obstacles in setting up Alabama eHealth network in rural areas. DSL, satellite, and other connectivity methods have proven to be cost prohibitive. An initial cost analysis is essential in order to launch and sustain a successful telehealth program.

Replication

Identifying a program champion (such as a hospital administrator, program leader, or medical provider) is key to ensuring that a telehealth program for PLWH/As will be successfully adopted and well-utilized by an agency's staff.

More practical steps on how to start a telemedicine program can be found in AIDS United's Making Connections: A Guide to Starting a Rural HIV Care Telemedicine Program (page 7).

Medical Advocacy & Outreach is available to answer any questions about their telehealth services and willing to work with medical facilities to implement telehealth programs. Contact Billy Sample (information below).

Contact Information

Billy Sample, Program Manager
MAO Telehealth Resource Center
Medical Advocacy & Outreach
334.386.3839
BSample@maoi.org