When distance matters: Mapping HIV health care underserved communities in sub-Saharan Africa.

Hana Kim,Diego F Cuadros,Godfrey N Musuka,Adam Branscum,Zindoga Mukandavire,Ransome Eke

doi:10.1371/journal.pgph.0000013

Abstract

Despite efforts to increase the proportion of individuals diagnosed with HIV who receive anti-retroviral therapy, 28% of people living with HIV (PLHIV) aged 15 years and older in eastern and southern Africa and 42% in western and central Africa were not receiving anti-retroviral therapy in 2019. Therefore, improving access to health care services is key to reduce HIV incidence and prevalence. The main aim of this study was to generate high-resolution maps of underserved areas where people cannot access the closest health care facilities within appropriate travel time in sub-Saharan Africa (SSA). Main sources of data for this study were the estimated number of PLHIV for adults aged 15-49 years in 47 countries in SSA and the global map of travel time to the nearest health care facility by motorized and non-motorized transportation. These data were used to estimate and map the number of PLHIV in underserved areas at a travel distance of 10, 30, and 60 minutes from the nearest healthcare facility. We identified and mapped more than 7 million PLHIV in the areas with a lack of access to health care within 10-minute travel time and 1.5 million PLHIV in the areas with a lack of access to health care within 60-minute travel time. The identified locations of underserved areas are an indicator of the challenge faced by PLHIV in accessing health services in SSA, a situation that is likely worsened by the COVID-19 pandemic. These findings can contribute to developing cost-effective geospatial policies for interventions aimed at underserved areas at a finer resolution for communities that have usually been identified in aggregated spatial areas. Further development and implementation of tailored intervention and treatment programs, especially in areas identified as underserved for PLHIV, should be explored. Geospatial analyses could complement the decision-making process with stakeholders to enhance healthcare access for PLHIV in SSA.

Highlights

HIV/AIDS has been a leading cause of morbidity and mortality for several decades in subSaharan Africa (SSA) [1,2,3]
The identified locations of underserved areas are an indicator of the challenge faced by people living with HIV (PLHIV) in accessing health services in sub-Saharan Africa (SSA), a situation that is likely worsened by the COVID-19 pandemic
The underserved areas based on 10-minute travel time to the nearest health care facility across the region covered about 90.5% of the total territory ( 21.8M km2; Fig 1A), while 74.6% (Fig 1B) and 58.9% (Fig 1C) of SSA had underserved areas that were within 30- and 60-minute thresholds, respectively

Summary

Introduction

HIV/AIDS has been a leading cause of morbidity and mortality for several decades in subSaharan Africa (SSA) [1,2,3]. Despite efforts to increase the proportion of individuals diagnosed with HIV who receive anti-retroviral therapy, 28% (95% confidence interval [CI]: 19–38%) of PLHIV aged 15 years and older in eastern and southern Africa and 42% (95% CI: 25–56%) of PLHIV aged 15 years and older in western and central Africa were not receiving anti-retroviral therapy in 2019 [5, 6] In this context, improving access to health care services is key to reduce HIV incidence and prevalence [2, 3]. In 2015, the Joint United Nations Programme on HIV/AIDS (UNAIDS) established the 9090-90 global targets (90% of all PLHIV know their HIV status, 90% of all people diagnosed with HIV receive sustained antiretroviral therapy, and 90% of all people receiving antiretroviral therapy have viral suppression) by 2020 for HIV treatment scale-up to end AIDS by 2030 This move highlighted that uninterrupted and expanded access to treatment via rapid scale-up is crucial for PLHIV, especially in resource-limited settings [3]. Removal of geographic barriers (e.g., proximity to health care for populations at high risk) and improving access to health services are vital to maintain essential health services and mitigate the impact of COVID-19 for PLHIV [2]

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Results

Discussion

Conclusion