GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda

Abstract

Objective Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects, possibly because a reliable, validated measure of transportation barriers has not been identified. Design Prospective cohort study of HIV-infected patients in rural Uganda. Methods Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara, Uganda as part of the Uganda AIDS Rural Treatment Outcomes (UARTO) Study. We collected the following measures of transportation barriers to HIV clinic: global positioning systems (GPS)-tracked distance measured by driving participants to their homes along their typical route; straight-line GPS distance from clinic to home, calculated with the Great Circle Formula; self-reported travel time; and self-reported travel cost. We assessed inter-measure agreement using linear regression, correlation coefficients and κ statistics (by measure quartile) and validated measures by fitting linear regression models to estimate associations with days late for clinic visits. Results One hundred and eighty-eight participants were tracked with GPS. Seventy-six percent were women, with a median age of 40 years and median CD4 cell count of 193 cells/μl. We found a high correlation between GPS-based distance measures (β = 0.74, P < 0.001, R2 = 0.92, k = 0.73), but little correlation between GPS-based and self-reported measures (all R2 ≤ 0.4). GPS-based measures were associated with days late to clinic (P < 0.001); but neither self-reported measure was associated (P > 0.85). Conclusion GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural, resource-limited settings.

Younger Age Predicts Failure to Achieve Viral Suppression and Virologic Rebound Among HIV-1-Infected Persons in Serodiscordant Partnerships

“…33 Predictors of nonadherence in subSaharan Africa include higher pill burden (twice-daily regimens vs. once-daily regimens), 34 stavudine-containing regimens, 35 geographic or transportation-related barriers, 36 and Global Positioning System measured distance from home to clinic. 37 In multiple settings, younger age predicts virologic rebound, and clinicians and ART programs should more effectively address behavioral, structural, and psychosocial barriers to ART adherence and provide adherence support for younger HIV-infected persons initiating ART.…”

Investigating Barriers to Tuberculosis Evaluation in Uganda Using Geographic Information Systems

“…Alternatively, patients may not report travel times accurately, as shown in another study from a rural region of Uganda where travel time reported by patients attending an HIV clinic differed from the measured time of travel. 42 It is unknown whether these differences would persist if they were evaluated with more precise residential localization. Although we assigned travel speeds to various land surfaces based on values used in other studies, 10,27 they may not capture the actual travel times experienced by our patients.…”

Care Management: Perspectives from Managers, Professionals and Users of a Specialized Service Facility Focused on Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome

“…This reorganization is justified primarily by the promising results reported in the literature for PLWHA who are monitored in a primary care setting [18] and by evidence that centralization of HIV/AIDS services and minimizing the distance between the homes of PLWHA and health facilities are factors that affect the likelihood that PLWHA will follow treatment protocols [19][20][21].…”