Addressing equity and access to care: How an academic family medicine practice manages human immunodeficiency virus, hepatitis C, and substance use disorders in rural Appalachia

Rural populations struggle with health care access and are influenced by social determinants of health, lack of available resources, and fragmented care. Longstanding disparity and inequity have led to increased prevalence and poor outcomes of preventable and treatable disease states, including human immunodeficiency virus (HIV), hepatitis C, and substance use disorders (SUD). This article describes how an academic family medicine center addresses access to care in a rural population with a high prevalence of HIV, hepatitis C, and SUD. The goal is to provide strategies that other practice sites could use to develop and expand their own services to enhance equity and improve outcomes in this patient population. Strategies include co-locating medical services to address multiple needs in one visit, leveraging telehealth to reduce barriers to care, utilizing multidisciplinary teams to promote comprehensive care, collaborating with community partners to address social determinants of health, and training health care learners to increase capacity and sustainability. The role of the pharmacist is highlighted as a leader of a team-based interdisciplinary care model that can meet complex patients' comprehensive care needs.