Access to Transportation Is Linked with Access to Effective HIV Care

Keith Henry, MD reviewing Goswami ND et al. J Acquir Immune Defic Syndr 2015 Dec 1.

Findings from zip code tabulation areas in metropolitan Atlanta

After being diagnosed with HIV infection, a patient should be linked quickly to effective care. Successful viral suppression may depend on a patient's location, income, and access to reliable transportation. Researchers used zip code tabulation areas (ZCTAs) within metropolitan Atlanta to assess how such neighborhood-level variables correlate with linkage to care within 3 months after HIV diagnosis and with viral suppression (<200 copies/mL).

From 2006 to 2010, within 100 ZCTAs, 8413 new HIV diagnoses were made (median, 60 per ZCTA). Among the ZCTAs, a median 51% of newly diagnosed patients were linked to care within 3 months, and a median 44% of patients achieved viral suppression by the end of 2010. The median number of bus stops within a ZCTA was 65, but it varied widely (interquartile range, 14–152); the median percentage of households that owned a vehicle was 93%.

The researchers found significant clustering of ZCTAs that had relatively lower rates of linkage to care and viral suppression. Within high-poverty ZCTAs, each 10% absolute increase in vehicle ownership was associated with a 4% absolute increase in the rate of linkage to care; within low-poverty ZCTAs, each 10% absolute increase in vehicle ownership was associated with a 30% absolute increase in the rate of viral suppression — both associations were statistically significant. Higher bus-stop count was significantly associated with viral suppression in the high-poverty stratum but not with linkage to care in either the high- or low-poverty stratum.

Citation(s):

Goswami ND et al. Understanding local spatial variation along the care continuum: The potential impact of transportation vulnerability on HIV linkage to care and viral suppression in high-poverty areas, Atlanta, Georgia. J Acquir Immune Defic Syndr 2015 Dec 1; [e-pub].