Understanding Local Spatial Variation Along the Care Continuum: The Potential Impact of Transportation Vulnerability on HIV Linkage to Care and Viral Suppression in High-Poverty Areas, Atlanta, Georgia

• Type of Material: Article
• Authors: Neela Goswami, Emory University; Michelle M. Schmitz, Emory University; Travis Sanchez, Emory University; Sharoda Dasgupta, Emory University; Patrick Sullivan, Emory University; Hannah Cooper, Emory University; Deepali Rane, Georgia Department of Public Health; Jane Kelly, Georgia Department of Public Health; Carlos Del Rio, Emory University; Lance Waller, Emory University
• Language: English
• Date: 2016-05-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Copyright 2015 Wolters Kluwer Health, Inc. All rights reserved.
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000000914
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 72
• Issue: 1
• Start Page: 65
• End Page: 72
• Grant/Funding Information: NIH/NIAID P30 AI050409 and the NIH/NIAID 1K23AI116388.; This study was supported by the Center for AIDS Research at Emory University (NIH/NIAID P30 AI050409), NIH/NIAID 1K23AI116388 and NIH R01 DA03510103.
• Keywords: Life Sciences & Biomedicine; spatial access; car ownership; Infectious Diseases; geospatial mapping; TRANSMISSION; HIV care cascade; Immunology; PREVENTION; Science & Technology; transportation
• Research Categories: Health Sciences, Immunology; Health Sciences, Public Health

Abstract

Background: Engagement in care is central to reducing mortality for HIV-infected persons and achieving the White House National AIDS Strategy of 80% viral suppression in the US by 2020. Where an HIV-infected person lives impacts his or her ability to achieve viral suppression. Reliable transportation access for healthcare may be a key determinant of this place-suppression relationship. Methods: ZIP code tabulation areas (ZCTAs) were the units of analysis. We used geospatial and ecologic analyses to examine spatial distributions of neighborhood-level variables (eg, transportation accessibility) and associations with: (1) community linkage to care, and (2) community viral suppression. Among Atlanta ZCTAs with data for newly diagnosed HIV cases (2006-2010), we used Moran I to evaluate spatial clustering and linear regression models to evaluate associations between neighborhood variables and outcomes. Results: In 100 ZCTAs with 8413 newly diagnosed HIV-positive residents, a median of 60 HIV cases were diagnosed per ZCTA during the 5-year period. We found significant clustering of ZCTAs with low linkage to care and viral suppression (Moran I = 0.218, P< 0.05). In high-poverty ZCTAs, a 10% point increase in ZCTA-level household vehicle ownership was associated with a 4% point increase in linkage to care (P = 0.02, R2 = 0.16). In low-poverty ZCTAs, a 10% point increase in ZCTA-level household vehicle ownership was associated with a 30% point increase in ZCTA-level viral suppression (P = 0.01, R2 = 0.08). Conclusions: Correlations between transportation variables and community-level care linkage and viral suppression vary by area poverty level and provide opportunities for interventions beyond individual-level factors.