Structural barriers to comprehensive, coordinated HIV care: geographic accessibility in the US South

AIDS Care
April D KimmelLindsay M Sabik

Abstract

Structural barriers to HIV care are particularly challenging in the US South, which has higher HIV diagnosis rates, poverty, uninsurance, HIV stigma, and rurality, and fewer comprehensive public health programs versus other US regions. Focusing on one structural barrier, we examined geographic accessibility to comprehensive, coordinated HIV care (HIVCCC) in the US South. We integrated publicly available data to study travel time to HIVCCC in 16 Southern states and District of Columbia. We geocoded HIVCCC service locations and estimated drive time between the population-weighted county centroid and closest HIVCCC facility. We evaluated drive time in aggregate, and by county-level HIV prevalence quintile, urbanicity, and race/ethnicity. Optimal drive time was ≤30 min, a common primary care accessibility threshold. We identified 228 service locations providing HIVCCC across 1422 Southern counties, with median drive time to care of 70 min (IQR 64 min). For 368 counties in the top HIV prevalence quintile, median drive time is 50 min (IQR 61 min), exceeding 60 min in over one-third of these counties. Among counties in the top HIV prevalence quintile, drive time to care is six-folder higher for rural versus super-urban counties. Count...Continue Reading

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Citations

Nov 30, 2018·Journal of Empirical Research on Human Research Ethics : JERHRE·Farirai MutenherwaTulio de Oliveira
May 22, 2019·Journal of the International AIDS Society·Steven P MasianoApril D Kimmel
Mar 27, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Rose S BonoApril D Kimmel
Dec 20, 2019·BMC Health Services Research·Melissa E CyrJames C Benneyan
Nov 4, 2020·Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America·Qianlai LuoMeredith Shiels
Jan 20, 2022·AIDS Care·Brett M TracyRandi N Smith

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