Nearly 1 in 5 People Living With HIV Have Suboptimal Geographic Access to HIV Care

Accessing HIV care is associated with higher retention in care and improved viral suppression, among other favorable outcomes. However, nearly 10% of people living with HIV have to travel more than an hour to access HIV care, according to a new study, which highlighted differences in drive times across urban and rural regions.

Using 4 federal databases to identify sites providing comprehensive HIV care, as well as publicly available data to estimate county-level drive time to HIV care in 48 states for 2013, the researchers found that nationally, the median drive time is 69 minutes.

The drive time for rural counties is more than twice that of urban counties (90 minutes vs 40 minutes). Among the total 671 HIV care sites in the United States, 95% reside in urban counties. The West had the most glaring differences, with median drive times for rural counties being triple that of urban counties (136 minutes vs 42 minutes). By region, the Northeast had median drive times of 40 minutes while the Midwest had median drive times of 81 minutes.

“With nearly every state, the median travel time was higher in rural counties compared with urban counties, although there was substantial variation between states in overall median drive time and in the size of urban—rural differences,” wrote the researchers.

With suboptimal accessibility defined as travel time of 30 minutes or more, 1995 (82%) counties and 171,569 (19%) people living with HIV are considered to have suboptimal access to HIV care. The majority of those with suboptimal access to care reside in the South (54%), followed by the West (20%), Midwest (15%), and Northeast (11%).

Notably, 27% of people with suboptimal access live in rural counties, although just 5% of people with an HIV diagnosis live in rural countries nationally.

Given the variability in access across the country, different regions will likely require unique solutions tailored to the needs of those specific populations, according to the researchers. Alternative solutions to providing access to care might include mobile HIV clinics, telemedicine, or HIV care through federally qualified health centers.

“While more research is needed prior to implementation to widespread implementation of any solution, the consistent finding of limited geographic accessibility in rural areas across all US regions highlights the need to reconsider patterns of HIV prevention and treatment funding that historically have allocated funds almost exclusively to urban areas,” wrote the researchers.

Reference:

Masiano S, Martin E, Bono R, et al. Suboptimal geographic accessibility to comprehensive HIV care in the US: reguonal and urban—rural differences [published online May 20, 2019]. J Int AIDS Soc. doi: 10.1002/jia2.25286.