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Disparities in the geographic accessibility of Ryan White HIV/AIDS program clinics in the United States

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BACKGROUND: The United States' (US) Ending the HIV Epidemic(EHE) initiative allocated funding to high burden jurisdictions to expand access to the Ryan White HIV/AIDS programs' (RWHAP) comprehensive care for low income people with HIV (PWH). US standards suggest one should travel <60 minutes to a specialist. We assessed geographic accessibility using drivetime to RWHAP clinics for PWH by subpopulations and policy context.
METHODS: Data were collected from publicly available sources (Centers for Disease Control and Prevention's AtlasPlus, US Census Bureau, Health Resources & Services Administration). Counties of the 48 contiguous US with a total population > 100 and HIV prevalence > 5 were included. We imputed data for counties with suppressed data. Drivetimes were calculated from each county's population-weighted center to the nearest RWHAP clinic and were weighted by PWH population size per county. Stratified by urban/rural, median drivetimes with 95% confidence intervals were calculated by bootstrap for subgroups (age, sex, race/ethnicity, HIV prevalence, EHE status).
RESULTS: Drivetimes and frequencies were calculated for 981,663 PWH within 2,499 US counties (Figure 1). Urban PWH (n=923,730) had a shorter drivetime (9.8 minutes; 95% CI: 6.9'12.9) compared to rural PWH (n=57,933; 75.8, 72.1'79.7). Within urban/rural, there was no drivetime difference by age or sex. Urban Native Hawaiian & Other Pacific Islander (NPHI) PWH (41.8, 38.4-45.3) had longer drivetimes than other racial groups. Rural Black PWH had shorter drivetimes, but all rural racial groups had drivetimes >60 minutes. Within urban counties, drivetime increases with decreasing HIV prevalence. Urban EHE counties had shorter drivetimes (6.7, 6.0-9.8) compared to their non-EHE counterparts (18.1, 14.1-23.2).


CONCLUSIONS: Poor geographic access (>60 minutes) to RWHAP clinics for urban subgroups of PWH and rural PWH is concerning. Spatial optimization studies are warranted to identify locations for RWHAP clinics/telemedicine-sites to improve access for PWH with long drivetimes.