Two studies have shown a volume outcome relationship in HIV care. A recent study of rural primary care physicians conducted by the University of California at San Francisco showed low volume HIV care providers had limited knowledge of newer management strategies, less use of protease inhibitors and viral load tests, and less familiarity with vertical HIV transmission prophylaxis. A second study showed low volume providers were less likely to prescribe HAART in accordance with current guidelines. The problem is some HIV patients who live in rural areas do not have easy access to HIV experienced providers found in the more urban settings. We hypothesized that an onsite-based consultation training program for low volume (less than 50 patients) rural providers would improve the consistency between provider practices and current recommendations and treatment guidelines for HIV. The training program was designed by the Pacific AIDS Education and Training Program. It begins with a needs assessment determined through filling out chart flow sheets. This is followed by an educational intervention that occurs through on-site clinical consultation. The provider's compliance with antiretroviral therapy and opportunistic infection guidelines is assessed prior to the initiation of the intervention and again at six and eighteen months post intervention. Initial data shows this intervention improves a provider's knowledge and skill for caring for HIV patients. It is an effective and sustainable training model for low volume HIV providers. A training package of this intervention is now under development for use in other rural areas within the United States. It is our impression that this has international implication. This package can be used to train healthcare work force in developing nations as they prepare to deal with HIV.