Identifying Spatial Variation Along the HIV Care Continuum: The Role of Distance to Care on Retention and Viral Suppression.

Abstract

Distance to HIV care may be associated with retention in care (RIC) and viral suppression (VS). RIC (≥ 2 HIV visits or labs ≥ 90days apartin 12 months), prescribed antiretroviral therapy (ART), VS (< 200 copies/mL at last visit) and distance to care were estimated among 3623 DC Cohort participants receiving HIV care in 13outpatient clinics in Washington, DC in2015. Logistic regression models and geospatial statistics were computed. RIC was 73%; 97% were on ART, among whom 77% hadVS. ZIP code-level clusters of low RIC and high VS were foundin NorthwestDC, andlow VS in SoutheastDC. Those traveling ≥ 5 miles had 30% lower RIC (adjusted odds ratio(aOR) 0.71, 95% CI 0.58, 0.86) and lower VS (OR 0.70, 95% CI 0.52, 0.94). Geospatial clustering of RIC and VS wasobserved, and distance may be abarrier to optimal HIV careoutcomes.