HIV-Experienced Clinician Workforce Capacity: Urban-Rural Disparities in the US South.

BACKGROUND: HIV-experienced clinicians are critical for positive outcomes along the HIV care continuum. However, access to HIV-experienced clinicians may be limited, particularly in nonmetropolitan areas, where HIV is increasing. We examined HIV clinician workforce capacity, focusing on HIV experience and urban-rural differences, in the US South. METHODS: We used Medicaid claims and clinician characteristics (Medicaid Analytic eXtract (MAX) and MAX Provider Characteristics, 2009-2011), county-level rurality (National Center for Health Statistics, 2013) and diagnosed HIV cases (AIDSVu, 2014) to assess HIV clinician capacity in 14 states. We assumed clinicians accepting Medicaid approximated the region's HIV workforce, since three-quarters of clinicians accept Medicaid insurance. HIV-experienced clinicians were defined as those providing care to >/=10 Medicaid enrollees over three years. We assessed HIV workforce capacity with county-level clinician-to-population ratios, using Wilcoxon-Mann-Whitney tests to compare urban-rural differences. RESULTS: We identified n=5,012 clinicians providing routine HIV management, of whom 28% were HIV-experienced. HIV-experienced clinicians were more likely to specialize in infectious diseases (48% vs 6%, p<0.001) and practice in urban areas (96% vs 83%, p<0.001) compared to non-HIV-experienced clinicians. The median clinician-to-population ratio for all HIV clinicians was 13.3 (interquartile range 38.0)), with no significant urban-rural differences. When considering HIV experience, 81% of counties had no HIV-experienced clinicians, and rural counties generally had fewer HIV-experienced clinicians per 1,000 diagnosed HIV cases (p<0.001). CONCLUSIONS: Significant urban-rural disparities exist in HIV-experienced workforce capacity for Southern US communities. Policies to improve equity in access to HIV-experienced clinical care for both urban and rural communities are urgently needed.