Travel Time to Clinic but not Neighborhood Crime Rate is Associated with Retention in Care Among HIV-Positive Patients

Ridgway, Jessica P; Almirol, Ellen; Schmitt, Jessica; Schuble, Todd; Schneider, John A.

doi:10.1007/s10461-018-2094-5

Cited by 28 publications

(19 citation statements)

References 16 publications

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“…This may be due to a number of interrelated factors relating to structural inequality and racialized experiences with healthcare. For example, neighbourhoods in Chicago with higher proportion Black inhabitants tend to be further from HIV care (85). This distance to HIV care is associated with poor retention in care (85).…”

Section: Discussionmentioning

confidence: 99%

“…For example, neighbourhoods in Chicago with higher proportion Black inhabitants tend to be further from HIV care (85). This distance to HIV care is associated with poor retention in care (85). Other barriers related to structural inequality that disproportionately impact Black populations are access to private insurance, housing insecurity, and incarceration (20,26,27).…”

Section: Discussionmentioning

confidence: 99%

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Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV

et al. 2021

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Retention in care and sustained viral suppression are integral outcomes in the care continuum for people living with HIV (PLWH) and HIV prevention; however, less is known about how substance use predicts sustained viral suppression over time. This study seeks to examine the predictive effects of substance use on sustained viral suppression in a sample of cisgender sexual minority men and gender minority PLWH (n=163) drawn from a longitudinal sample in the Chicago area collected 2015-2019. Using data from 3 visits separated by 6 months, participants were coded persistently detectable, inconsistently virally suppressed, and consistently virally suppressed (<40 copies/mL at all visits). Multinomial logistic regressions were utilized. About 40% of participants had sustained viral suppression. In multinomial logistic regressions, CUDIT-R predicted persistent detectable status and stimulant use was associated with inconsistent viral suppression. Substance use may create challenges in achieving sustained viral suppression, which has important implications for care and prevention.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV

et al. 2021

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“…Patients' addresses were geocoded and the travel distance and travel time to the clinic as well as the crime rate along the travel rate were calculated. Geocoding methods have been previously described 28 . Using data from the American Community Survey (US Census Bureau), characteristics of a patient's community at the census tract level including racial composition, fraction of population on Supplemental Nutrition Assistance Program, commute characteristics and education levels were collected 29 .…”

Section: Methodsmentioning

confidence: 99%

Predictive Analytics for Retention in Care in an Urban HIV Clinic

Ramachandran

Kumar

Koenig

et al. 2020

Sci Rep

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consistent medical care among people living with HiV is essential for both individual and public health. HIV-positive individuals who are 'retained in care' are more likely to be prescribed antiretroviral medication and achieve HIV viral suppression, effectively eliminating the risk of transmitting HIV to others. However, in the United States, less than half of HIV-positive individuals are retained in care. Interventions to improve retention in care are resource intensive, and there is currently no systematic way to identify patients at risk for falling out of care who would benefit from these interventions. We developed a machine learning model to identify patients at risk for dropping out of care in an urban HIV care clinic using electronic medical records and geospatial data. The machine learning model has a mean positive predictive value of 34.6% [SD: 0.15] for flagging the top 10% highest risk patients as needing interventions, performing better than the previous state-of-the-art logistic regression model (PPV of 17% [SD: 0.06]) and the baseline rate of 11.1% [SD: 0.02]. Machine learning methods can improve the prediction ability in HIV care clinics to proactively identify patients at risk for not returning to medical care. Consistent medical care is essential for the health of people living with HIV. HIV-positive individuals who receive regular medical care are more likely to receive antiretroviral therapy, less likely to develop Acquired Immune Deficiency Syndrome (AIDS), and have improved survival rates compared to HIV-positive individuals who do not receive regular medical care 1-3. In the field of HIV medicine, patients who receive regular medical care are considered 'retained in care. ' Retention in care is not only important for the individual health of people living with HIV, but also for public health. HIV-positive individuals who are retained in care and taking antiretroviral therapy are able to suppress the HIV viral level in their serum to undetectable levels, effectively eliminating the risk of transmitting HIV to others. Accordingly, retention in care is a critical pillar of public health agency plans to eliminate HIV transmission in the United States 4-6. Despite the clear benefits of retention in care for individual and public health, less than half of individuals living with HIV in the U.S. are retained in care. Lack of access to healthcare is one reason that patients may not be retained in care 7. However, for patients who lack health insurance, state and federal programs such as the Ryan White HIV/AIDS Program provide funding to pay for HIV care visits and antiretroviral medications. Despite these programs, many patients living with HIV still do not regularly attend medical appointments. Additional barriers to retention in care remain, including mental illness, substance use, insecure housing, poverty, neighborhood violence, and stigma 8-16. Interventions that are effective for improving retention in care include intensive case management, peer navigation, and multi-faceted outreach progra...

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“…Studies have shown that transportation barriers have a significant impact on health outcomes, particularly among disadvantaged individuals [32,33]. Regarding HIV care and treatment, travel time has been found to be a barrier to retention in care [34,35].…”

Section: Discussionmentioning

confidence: 99%

Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

Ojikutu¹,

Bogart²,

Mayer³

et al. 2019

JMIR Public Health Surveill

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Background Uptake of pre-exposure prophylaxis (PrEP) among black individuals in the United States is low and may be associated with the limited availability of clinics where PrEP is prescribed. Objective We aimed to determine the association between spatial access to clinics where PrEP is prescribed and willingness to use PrEP. Methods We identified locations of clinics where PrEP is prescribed from AIDSVu.org and calculated the density of PrEP clinics per 10,000 residents according to the ZIP code. Individual-level data were obtained from the 2016 National Survey on HIV in the Black Community. We used multilevel modelling to estimate the association between willingness to use PrEP and clinic density among participants with individual-level (HIV risk, age, gender, education, income, insurance, doctor visit, census region, urban/rural residence) and ZIP code–level (%poverty, %unemployed, %uninsured, %black population, and density of health care facilities) variables. Results All participants identified as black/African American. Of the 787 participants, 45% were men and 23% were found to be at high risk based on the self-reported behavioral characteristics. The mean age of the participants was 34 years (SD 9), 54% of participants resided in the South, and 26% were willing to use PrEP. More than one-third (38%) of the sample had to drive more than 1 hour to access a PrEP provider. Participants living in areas with higher PrEP clinic density were significantly more willing to use PrEP (one SD higher density of PrEP clinics per 10,000 population was associated with 16% higher willingness [adjusted prevalence ratio=1.16, 95% CI: 1.03-1.31]). Conclusions Willingness to use PrEP was associated with spatial availability of clinics where providers prescribe PrEP in this nationally representative sample of black African Americans.

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Travel Time to Clinic but not Neighborhood Crime Rate is Associated with Retention in Care Among HIV-Positive Patients

Cited by 28 publications

References 16 publications

Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV

Substance Use Predicts Sustained Viral Suppression in a Community Cohort of Sexual and Gender Minority Youth Living with HIV

Predictive Analytics for Retention in Care in an Urban HIV Clinic

Spatial Access and Willingness to Use Pre-Exposure Prophylaxis Among Black/African American Individuals in the United States: Cross-Sectional Survey

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