Impact of Geographic and Transportation-Related Barriers on HIV Outcomes in Sub-Saharan Africa: A Systematic Review

Abstract

Difficulty obtaining reliable transportation to clinic is frequently cited as a barrier to HIV care in sub-Saharan Africa (SSA). Numerous studies have sought to characterize the impact of geographic and transportation-related barriers on HIV outcomes in SSA, but to date there has been no systematic attempt to summarize these findings. In this systematic review, we summarized this body of literature. We searched for studies conducted in SSA examining the following outcomes in the HIV care continuum: (1) voluntary counseling and testing, (2) pre-anti-retroviral therapy (ART) linkage to care, (3) loss to follow-up and mortality, and (4) ART adherence and/or viral suppression. We identified 34 studies containing 52 unique estimates of association between a geographic or transportation-related barrier and an HIV outcome. There was an inverse effect in 23 estimates (44 %), a null association in 26 (50 %), and a paradoxical beneficial impact in 3 (6 %). We conclude that geographic and transportation-related barriers are associated with poor outcomes across the continuum of HIV care.

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

“…32 In a prospective study of 1,305 HIV-1-infected persons on ART in British Columbia, younger age was independently associated with viral rebound after initial viral suppression. 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.…”

Disclosure of physical, emotional and sexual child abuse, help-seeking and access to abuse response services in two South African Provinces

“…Within South Africa, qualitative research suggests that professional services are not designed to facilitate abuse disclosure and service access for children (Bray, Gooskens, Kahn, Moses, & Seekings, 2010). Some of the perceived barriers are logistical and practical obstacles, such as transport or money (Lankowski, Siedner, Bangsberg, & Tsai, 2014); inadequate and badly designed services and poor service delivery (Roehrs, 2011); lack of faith in a timely and positive outcome (Smith, Bryant-Davis, Tillman, & Marks, 2010); fear of repercussions such as re-victimisation (Akal, 2005); and stigma and coercion within the family (Akal, 2005;Bray et al, 2010). The low numbers of children disclosing directly to professionals and receiving services in our present study support these qualitative findings.…”

Tackling virological failure in HIV-infected children living in Africa

“…Improving our understanding of the effect of nutritional status on the body's response to HIV infection should be a priority as improving nutrition may be an economically feasible method to improve outcomes among HIV-infected children. Another major issue that should not be overlooked is the association between geographic and transportation barriers with poor HIV outcomes [106]. As discussed by Lankoswki et al, transportation-related barriers may be lessened by investing in rural health care infrastructure, decentralization of services, use of simplified management protocols feasible for use in primary care and provision of transport stipends [106].…”