Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression

Abstract

Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90 days apart in 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13 outpatient clinics in Washington, DC in 2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% had VS. ZIP code-level clusters of low RIC and high VS were found in Northwest DC, and low VS in Southeast DC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio (aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS was observed, and distance may be a barrier to optimal HIV care outcomes.

Keywords: Care continuum; Distance; Retention; Spatial patterns; Viral suppression.

Figure 1.. Geography, density, distance to care to HIV care, retention-in-care (RIC) and viral suppression (VS) by ZIP code of residence in Washington, DC 2014-2015

A, % participants residing in ZIP codes with areas in darker blue representing ZIP codes with higher percentages. Red circles and yellow triangles represent DC Cohort community-based and hospital-based clinics, respectively. B, Median distance to care site with areas in darker blue representing ZIP codes with participants travelling longer distances to care. C, RIC % (Quartiles) with areas in darker blue representing ZIP codes with higher RIC. D, VS% (Quartiles) with areas in darker blue representing ZIP codes with higher VS.

Figure 2.. Hot spot analysis of retention-in-care (RIC) and viral suppression (VS) in Washington, DC 2014-2015

A, RIC. B, VS.