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Conceptualizing and quantifying access to HIV care among people living with HIV in Atlanta, Georgia

Dasgupta, Sharoda (2015)
Dissertation (215 pages)
Committee Chair / Thesis Advisers: Sullivan, Patrick S; Sanchez, Travis
Committee Members: Kramer, Michael R ; Rosenberg, Eli S
Research Fields: Health Sciences, Epidemiology; Health Sciences, Public Health
Keywords: HIV; access to care; spatial epidemiology; Atlanta
Program: Laney Graduate School, Epidemiology
Permanent url: http://pid.emory.edu/ark:/25593/pg4bf

Abstract

Regular medical care utilization among people living with HIV (PLWH) is important in maintaining viral load suppression and reducing transmission to others. Access to medical care affects healthcare-seeking behaviors among PLWH, and encompasses both spatial accessibility (characterized by travel-related factors, such as proximity and travel mode) and provider-related characteristics. In this dissertation, we examined different facets of access to HIV care resources in Atlanta, Georgia. In the first study, we assessed usability of a Google map question embedded in a Web-based survey as a valid and reliable alternative to collecting address-based data on important HIV-related locations, such as residence and last attended HIV provider. The map tool demonstrated strong validity but varying reliability by recruitment mode in identifying these key locations. In the second study, we investigated whether using public transportation, an aspect of spatial accessibility, is a barrier to accessing HIV care, and examined differences in trends by geographic region. Public transportation use was associated with lower rates of HIV care attendance in south Atlanta. Participants in south Atlanta also lived in areas with lower household vehicle access and were more likely to use public transportation. In the third study, we more extensively quantified spatial accessibility to HIV providers with respect to case count, poverty, and household vehicle access. The findings suggested that census tracts with poorer accessibility coincided with areas of high case burden, high poverty, and lower household vehicle access in urban south Atlanta. In the fourth study, we combined dimensions of spatial accessibility and provider-related characteristics in a novel tool to (1) comprehensively quantify access to HIV services (supply) by mode of transportation, and (2) identify underserved areas with respect to HIV cases (demand) in Atlanta. Access to HIV primary care was greater in urban areas. Overlapping areas of high HIV case burden (demand) and low access (supply) were observed in parts of urban south and northeast Atlanta. These results demonstrate that access to HIV care varies spatially and by factors related to socioeconomic status. Identifying areas with poor access can help address gaps in HIV care engagement and improve important HIV clinical outcomes.

Table of Contents

Chapter 1: Background and Significance -- -- -- Chapter 2: Data sources -- -- Chapter 3: Use of a Google Map Tool Embedded in an Internet Survey Instrument: Is it a Valid and Reliable Alternative to Geocoded Address Data? -- -- Chapter 4: Effect of commuting patterns on HIV care attendance among HIV-positive Atlanta-based MSM -- -- Chapter 5: Spatial accessibility to HIV providers in Atlanta, Georgia -- -- Chapter 6: Development and application of a novel measure of access to HIV providers in Atlanta, Georgia -- -- Chapter 7: Conclusion and future directions -- -- Appendix A: The Engage Study questionnaire -- -- Appendix B: Information obtained from each major HIV provider in Atlanta -- -- Appendix C: Additional analysis conducted for Chapter 6 --
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