Development of a comprehensive measure of spatial access to HIV provider services, with application to Atlanta, Georgia

• Type of Material: Article
• Authors: Sharoda Dasgupta, Emory University; Michael Kramer, Emory University; Eli Rosenberg, Emory University; Travis Sanchez, Emory University; Patrick Sullivan, Emory University
• Language: English
• Date: 2016-07-04
• Publisher: SpringerOpen
• Publication Version: Final Published Version
• Copyright Statement: © 2016, The Author(s).
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1186/s40064-016-2515-8
• Title of Journal or Parent Work: SpringerPlus
• ISSN: 2193-1801
• Volume: 5
• Issue: 1
• Start Page: 984
• End Page: 984
• Grant/Funding Information: The National Institute of Mental Health (Grant Number R01MH085600), Eunice Kennedy Shriver National Institute for Child Health and Human Development (Grant Number R01HD067111), Emory University Center for AIDS Research (Grant Number P30AI050409), and Professional Development Support Funds provided by Laney Graduate School, Emory University financially supported the Engage Study.
• Keywords: ACCESSIBILITY; Multidisciplinary Sciences; MATTER; DISPARITIES; Science & Technology; Healthcare services; ANCILLARY SERVICES; NEIGHBORHOOD; PRIMARY-HEALTH-CARE; Travel mode; Science & Technology - Other Topics; Spatial access; HIV; NAVIGATION; MODEL; PUBLIC TRANSPORTATION
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Background: No existing measures of HIV care access consider both spatial proximity to services and provider-related characteristics in a single measure. We developed and applied a tool to: (1) quantify spatial access to HIV care services (supply) and (2) identify underserved areas with respect to HIV cases (demand), by travel mode, in Atlanta. Methods: Building on a study of HIV care engagement, data from an HIV care provider database, and HIV case counts by zip code tabulation area (ZCTA) from AIDSVu.org, we fit a discrete choice model to estimate practice characteristics most salient in defining patient care access. Modified spatial gravity modeling quantified supply access based on discrete choice model results separately for travel by car and by public transportation. Relative access scores were calculated by ZCTA, and underserved areas (defined as having low supply access and high HIV case count) were identified for each travel mode. Results: Characteristics retained in the final model included: travel distance, available provider-hours, availability of ancillary services, and whether Ryan White patients were accepted. HIV provider supply was higher in urban versus suburban/rural areas for both travel modes, with lower supply access if traveling by public transportation. Underserved areas were concentrated in south and east Atlanta if traveling by public transportation, overlapping with many areas of high poverty. Approximately 7.7 %, if traveling by car, and 64.3 %, if traveling by public transportation, of Atlanta-based persons with diagnosed HIV infection resided in underserved areas. Conclusion: These findings highlight underserved areas in south and east Atlanta if traveling by public transit. Conceptualizing access to medical services spatially and by travel mode may help bridge gaps between patient needs and service availability and improve HIV outcomes.