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Measuring Spatial Access of Vulnerable Population to HIV Testing Facilities in the Baton Rouge Metropolitan Statistical Area, Louisiana

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Abstract

Ensuring adequate and equitable access to affordable HIV testing is a crucial step toward ending the HIV epidemic (EHE). Using the high-burden Baton Rouge Metropolitan Statistical Area (MSA) as an example, we measure spatial access to HIV testing facilities for vulnerable populations and assess whether their access would improve if eliminating a considerable barrier—costs. Locations and status (free, low-cost, and full cost) of HIV testing facilities are searched on the Internet and confirmed through a field survey. Vulnerable populations include the uninsured and people living with HIV (PLWH), disaggregated from county-level HIV prevalence data. Spatial access is computed by a normalized urban-rural two-step floating catchment area (NUR2SFCA) method. Our survey confirms that only 11% and 37% of the 103 Internet-searched HIV testing facilities are indeed free and low-cost. Making more facilities cheaper or free increases the average access of PLWH, the uninsured, and the entire population but their geographic patterns vary. Free testing facilities, clustered in Baton Rouge city, are highly accessible to 82.6%, 69.4%, and 70.2% of three population groups living in East and West Baton Rouge Parish. In comparison, making all low-cost facilities free increases access in most outlying parishes but at the cost of reducing access in East Baton Rouge Parish, leaving west Livingston, north Iberville, and east Pointe Coupee Parish with the poorest access. Making all full-cost facilities cheaper or free exhibits a similar pattern. The study has important policy implications for where and how to improve access to HIV testing for vulnerable populations.

Resumen

Medimos el acceso espacial a las instalaciones de pruebas de VIH para poblaciones vulnerables y evaluamos si su acceso mejoraría si se eliminaran las barreras de costos, utilizando como ejemplo el área estadística metropolitana de Baton Rouge, que tiene una alta carga. Nuestra encuesta confirma que el 11% y el 37% de los 103 centros de pruebas de VIH buscados en Internet son efectivamente gratuitos y de bajo costo. Hacer que más instalaciones sean más baratas o gratuitas aumenta el acceso promedio de las PLWH, las personas sin seguro y toda la población, pero sus patrones geográficos varían. Las instalaciones de pruebas gratuitas, agrupadas en la ciudad de Baton Rouge, son muy accesibles para el 82,6%, el 69,4% y el 70,2% de los tres grupos de población del este y oeste de Baton Rouge. En comparación, hacer que las instalaciones de bajo costo sean gratuitas aumenta el acceso en las parroquias periféricas, pero a costa de reducir el acceso en East Baton Rouge. Hacer que las instalaciones de costo total sean más baratas o gratuitas muestra un patrón similar. El estudio tiene importantes implicaciones políticas para mejorar el acceso a las pruebas del VIH para las poblaciones vulnerables.

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Data Availability

The populations and various variables used to estimate PLWH are extracted from the 2014–2018 American Community Survey (ACS) on the U.S. Census Bureau’s website: https://www2.census.gov/geo/tiger/TIGER_DP/2018ACS/. The HIV prevalence rate data are extracted from the AIDSVu website: https://aidsvu.org/. The road network is extracted from the United States Geological Survey (USGS): https://data.usgs.gov/datacatalog/data/USGS:ad3d631d-f51f-4b6a-91a3-e617d6a58b4e. Some HIV testing facilities are listed in Appendix, and the full list of HIV testing facilities can be requested from the corresponding author. We use ArcGIS Pro to calculate the spatial accessibility of each population group to different groups of HIV testing facilities. We run the GWR model in ArcGIS Pro and the MLR model in the R software to estimate PLWH.

Abbreviations

ACS:

American Community Survey

AIC:

Akaike Information Criterion

CDC:

Centers for Disease Control and Prevention

EHE:

Ending the HIV Epidemic

GIS:

Geographic Information Systems

GWR:

Geographically Weighted Regression

MSM:

Men who have sex with men

MSA:

Metropolitan Statistical Area

PLWH:

People Living with HIV

PrEP:

Pre-Exposure Prophylaxis

RUCAs:

Rural-Urban Commuting Area Codes

SMLR:

Stepwise Multiple Linear Regression

SPAR:

Spatial Access Ratio

2SFCA:

Two-Step Floating Catchment Area

UNAIDS:

Joint United Nations Programme on HIV/AIDS

UR2SFCA:

Urban-Rural Two-Step Floating Catchment Area

U.S.:

United States

USDA:

U.S. Department of Agriculture

USGS:

United States Geological Survey (USGS)

VIF:

Variance Inflation Factor

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Acknowledgements

Alina Prigozhina would like to thank the Department of Geography and Anthropology at Louisiana State University for funding of the R. C. West and R. J. Russell Graduate Student Field Research Award for the field survey to confirm HIV testing facilities. We would like to thank the editor and two anonymous reviewers for their valuable and constructive comments to help us prepare an improved version of our paper.

Funding

This study was supported by LSU R. C. West and R. J. Russell Graduate Student Field Research Award.

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Authors and Affiliations

  1. Department of Geography and the Environment, University of Alabama, Tuscaloosa, AL, 35401, USA

    Changzhen Wang

  2. Independent Researcher, East Lansing, MI, USA

    Alina Prigozhina

  3. Department of Geography and Anthropology, Louisiana State University, Baton Rouge, LA, 70803, USA

    Michael Leitner

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  1. Changzhen Wang
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Correspondence to Changzhen Wang.

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Wang, C., Prigozhina, A. & Leitner, M. Measuring Spatial Access of Vulnerable Population to HIV Testing Facilities in the Baton Rouge Metropolitan Statistical Area, Louisiana. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04304-3

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