Urban-rural disparities in geographic accessibility to care for people living with HIV

Bono, Rose S; Pan, Zhongzhe; Dahman, Bassam; Deng, Yangyang; Kimmel, April D.

doi:10.1080/09540121.2022.2141186

Cited by 4 publications

(6 citation statements)

References 30 publications

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“…While our findings contrast with global literature which conclude rural populations face greater disparities in access to HIV primary care, testing, and other health care resources [71][72][73][74][75], our findings point to the importance of the types of key populations which may reside in urban areas compared to rural areas. Labor migrants are disproportionately more likely to reside in rural areas [76] including the wives of migrants who may be affected while other key populations like PWID, MSM, and CSWs are more likely to reside in urban areas [63,77].…”

Section: Gender Variation In Hiv Early Detectioncontrasting

confidence: 99%

Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan

Alaei,

Kwan,

Torabzadeh

et al. 2024

Preprint

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HIV early detection (CD4 counts ≥350 cells/μL) is correlated with higher life expectancy among people living with HIV (PLHIV). Several factors including physical, cultural, structural, and financial barriers have contributed to HIV late detection. This is the first-of-its-kind study on the regional differences in early detection of HIV within Tajikistan and any country in the Central Asia region. Utilizing Tajikistan Ministry of Health's national HIV data (N=10,700) spanning 2010 to 2023, we developed median regression models with median CD4 cell count as the outcome and as predictors: time (years), region, age, gender, and area (urban/rural status). Individuals younger than 19 years old are more likely to be detected early for HIV, whereas those older than 39 years are more prone to late detection. Given their active engagement in age-related and sexual activities, those older than 39 years face a higher risk of HIV transmission to others if diagnosed late. Therefore, they require further attention and targeted interventions. Females are detected earlier compared to their male counterparts, regardless of region of residence. Rural populations are detected earlier in most years compared to their urban counterparts. The COVID-19 pandemic accelerated HIV early detection in 2021 but most regions have returned to near pre-pandemic levels of detection in 2022 and 2023. These fluctuations in early detection may signify a shift in attention and resource allocation, potentially affecting efforts to address access gaps during the initial year of the COVID-19 pandemic. There are significant health inequities among different demographic and geographic groups which warrant further attention.

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Section: Gender Variation In Hiv Early Detectioncontrasting

confidence: 99%

Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan

Alaei,

Kwan,

Torabzadeh

et al. 2024

Preprint

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“…5 Previous studies reported up to 4 times greater travel time for health care by rural residents compared with urban residents, with many rural residents seeking care in nonadjacent counties. 3,7 Reasons for the disparity are multifactorial, from scarcity of specialized health services to insufficient public transport. 8 Although the housing type and transportation dimension of EDI was lower for rural compared with urban residents in this analysis, overall increased social vulnerability might have decreased the ability of rural residents to travel for vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…Stigma around sexually transmitted infections and against the MSM community in rural communities might have also impacted travel behaviors associated with vaccination. 4,7 In New Mexico, approximately 80% of rural residents who were vaccinated against mpox did not identify as White, non-Hispanic, or Latino, and approximately half identified as AI/ AN. The vaccination rate among AI/AN-identifying persons was similar in rural and urban counties, possibly attributable to increased vaccination acceptance and awareness due to the COVID-19 pandemic and access to mpox vaccinations at Indian Health Service facilities located on tribal land in rural areas.…”

Section: Discussionmentioning

confidence: 99%

“…In Idaho, rural residents were less likely to receive the second dose, which might limit vaccine protection 5 . Previous studies reported up to 4 times greater travel time for health care by rural residents compared with urban residents, with many rural residents seeking care in nonadjacent counties 3,7 . Reasons for the disparity are multifactorial, from scarcity of specialized health services to insufficient public transport 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Although the housing type and transportation dimension of EDI was lower for rural compared with urban residents in this analysis, overall increased social vulnerability might have decreased the ability of rural residents to travel for vaccination. Stigma around sexually transmitted infections and against the MSM community in rural communities might have also impacted travel behaviors associated with vaccination 4,7 …”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Effects of rurality on distance and time traveled to receive vaccination against Mpox — New Mexico and Idaho 2022–2023

Stadelman-Behar,

Cahill,

Newell

et al. 2023

Sexual Trans Dis

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Drive time to care and retention in HIV care: Rural–urban differences among Medicaid enrollees in the United States South

Kimmel,

Bono,

Pan

et al. 2024

The Journal of Rural Health

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PurposeLess than 50% of people with HIV (PWH) in the United States are retained in care, a key step along the HIV care continuum. We examined the impact of geographic access to care on retention in care for urban and rural PWH.MethodsWe used Medicaid claims and clinician data (Medicaid Analytic eXtract and MAX Provider Characteristics, 2009–2012) for 13 Southern states plus the District of Columbia. We calculated drive time from the enrollees’ ZIP Code Tabulation Area to their usual source of care. We used generalized estimating equations to examine the association between drive time to care >30 min (versus ≤30 min) and retention in care, overall and stratified by rurality. In sensitivity analysis, we examined the definition of retention in care, states included in the analysis, and enrollee‐ and care‐related characteristics.FindingsThe sample included 49,596 PWH. Overall, the association between drive time >30 min and retention was significant, but small (adjusted odds ratio [aOR] 1.01, 95% confidence interval [CI] 1.00, 1.01) and was not significant in urban areas; however, the significance and direction of the association differed in sensitivity analysis. In rural areas, driving >30 min to care was associated with 7% higher odds of retention in care (aOR 1.07, 95% CI 1.05, 1.08) and this association remained significant and positive in nearly all sensitivity analyses.ConclusionsFor PWH in rural areas, greater drive time is consistently associated with greater retention in care. Disentangling the mechanisms of this relationship is a future research priority.

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Urban-rural disparities in geographic accessibility to care for people living with HIV

Cited by 4 publications

References 30 publications

Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan

Regional Health Divides: Understanding Inequities in Late Diagnosis of HIV in Tajikistan

Effects of rurality on distance and time traveled to receive vaccination against Mpox — New Mexico and Idaho 2022–2023

Drive time to care and retention in HIV care: Rural–urban differences among Medicaid enrollees in the United States South

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