Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression
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.
KeywordsDistance Spatial patterns Retention Viral suppression Care continuum
This work was supported by the National Institute of Allergy and Infectious Diseases at the National Institutes of Health under Grant UO1 AI69503-03S2. Data in this manuscript were collected by the DC Cohort investigators and research staff located at: Cerner Corporation (Jeffrey Binkley, Cheryl Akridge, Thila Subramanian, Qingjiang Hou, Stacey Purinton, Nabil Rayeed, Rob Taylor and Kate Shelton); Children’s National Medical Center Adolescent (Lawrence D’Angelo) and Pediatric (Natella Rakhmanina) clinics; The Senior Deputy Director of the DC Department of Health HAHSTA (Michael Kharfen); Family and Medical Counseling Service (Michael Serlin); Georgetown University (Princy Kumar); George Washington Medical Faculty Associates (David Parenti); George Washington University Department of Epidemiology and Biostatistics (James Peterson, Lindsey Powers Happ, Maria Jaurretche, Brittany Wilbourn, and Kevin Trac); Howard University (Ronald Wilcox); La Clinica Del Pueblo (Ricardo Fernandez); MetroHealth (Annick Hebou); National Institutes of Health (Carl Dieffenbach and Henry Masur); Unity Health Care (Gebeyehu Teferi); Veterans Affairs Medical Center (Debra Benator); Washington Hospital Center (Maria Elena Ruiz); Whitman-Walker Health (David Hardy, Deborah Goldstein); Kaiser Permanente (Michael Horberg). We would also like to acknowledge the Research Assistants at all of the participating sites, the DC Cohort Community Advisory Board and the DC Cohort participants.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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