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. 2014 Jul;18(7):1199-223.
doi: 10.1007/s10461-014-0729-8.

Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review

Alexander J Lankowski  1 , Mark J Siedner, David R Bangsberg, Alexander C Tsai
Affiliations

Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review

Alexander J Lankowski et al. AIDS Behav. 2014 Jul.

Abstract

Difficulty obtaining reliable transportation to clinic is frequently cited as a barrier to HIV care in sub-Saharan Africa (SSA). Numerous studies have sought to characterize the impact of geographic and transportation-related barriers on HIV outcomes in SSA, but to date there has been no systematic attempt to summarize these findings. In this systematic review, we summarized this body of literature. We searched for studies conducted in SSA examining the following outcomes in the HIV care continuum: (1) voluntary counseling and testing, (2) pre-antiretroviral therapy (ART) linkage to care, (3) loss to follow-up and mortality, and (4) ART adherence and/or viral suppression. We identified 34 studies containing 52 unique estimates of association between a geographic or transportation-related barrier and an HIV outcome. There was an inverse effect in 23 estimates (44 %), a null association in 26 (50 %), and a paradoxical beneficial impact in 3 (6 %). We conclude that geographic and transportation-related barriers are associated with poor outcomes across the continuum of HIV care.

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Conflict of interest statement

We declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram of studies identified for review. Studies were identified using a systematic search of PubMed and Web of Science (WoS), as well as manual search of conference abstracts from the International Association of Physicians in AIDS Care (IAPAC) annual meeting from 2002 to 2011
See this image and copyright information in PMC

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