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Abstract
Rural residence may influence HIV outcomes by limiting access to specialized care. Using Oregon’s 2007 Medical Monitoring Project, we conducted a cross‑sectional analysis of 296 adults with HIV to examine whether rural residence and travel time to care were associated with recent CD4 ≥350 cells/µL. Logistic regression showed sex‑specific patterns: rural men had lower odds of CD4 ≥350 than non‑rural men (≈51% lower; p=0.067), whereas rural women had higher odds than non‑rural women (OR 10.16; p=0.020). Travel time moderated outcomes: among patients living ≤1 hour from their provider, higher historical nadir CD4 was strongly associated with CD4 ≥350 (p<0.001), an association that was weaker and nonsignificant for those >1 hour away. Findings indicate a complex, gender‑differentiated rural effect and suggest access factors shape immunologic status.