Harrison Sayward Elizabeth, Hung Peiyin, Green Katherine, Miller Sarah J, Paton Mariajosé, Ahuja Divya, Weissman Sharon, Rudisill Caroline, Evans Tammeka
Department of Psychology, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.
Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
BMC Public Health. 2025 Mar 8;25(1):926. doi: 10.1186/s12889-025-22090-y.
People living with HIV (PLHIV) in the southern United States (US) are at high risk for poor outcomes across the HIV care continuum leading to low rates of viral suppression. Understanding structural barriers to care-including transportation vulnerability-is critical to improve HIV outcomes. This study investigated relationships between travel time to HIV care, transportation vulnerability, and HIV care disruptions to inform future transportation interventions for PLHIV residing in South Carolina and other southern US states.
A total of 160 PLHIV (N = 160) were recruited from a large immunology center in South Carolina. Participants reported on transportation experiences, transportation vulnerabilities, and residence. Differences in sociodemographic characteristics, transportation vulnerabilities, and HIV care disruptions were compared across travel time groups (< 15, 15-30, and > 30 min from residential location to the HIV clinic) using Mantel-Haenszel Chi-Square tests. Multivariable logistic regression tested our a priori hypothesis that travel time would predict HIV care disruptions.
A majority of participants were aged 45-64 years old (54.4%), single (77.0%), male (63.8%), and Black (77.5%). Nearly 20% of participants lived < 15 min from their HIV clinic, 59.1% lived 15-30 min, and 21.4% lived > 30 min away. PLHIV who had to travel > 30 min to HIV care were more likely than those living < 15 min away to report transportation vulnerability (73.5% vs. 51.6%, p = 0.048), missed HIV care appointments (64.7% vs. 41.9%, p = 0.049), and transportation challenges that prevented them from seeing HIV care providers (67.7% vs. 39.4%; p = 0.014). Adjusted odds ratios (AOR) show that PLHIV who had to travel > 30 min were more likely to experience transportation-related disruptions to HIV care, including being late to appointments (AOR 5.25, 95% CI:1.06-25.92), missing appointments (AOR 3.85, 95% CI:1.04-15.89), and being unable to see HIV providers (AOR 7.06, 95% CI:0.59-14.89).
In South Carolina-a rural southern state with a disproportionate burden of HIV-long travel time (> 30 min) to HIV care is associated with care disruptions, including more missed visits. Transportation interventions, as well as other efforts to expand rural access to HIV care, are urgently needed to ensure that all PLHIV are able to engage in consistent HIV care in order to reach and maintain viral suppression.
美国南部的艾滋病毒感染者（PLHIV）在整个艾滋病毒护理连续过程中面临不良结局的高风险，导致病毒抑制率较低。了解护理的结构性障碍，包括交通易损性，对于改善艾滋病毒结局至关重要。本研究调查了前往艾滋病毒护理机构的出行时间、交通易损性和艾滋病毒护理中断之间的关系，以为居住在南卡罗来纳州和美国其他南部州的PLHIV的未来交通干预措施提供信息。
从南卡罗来纳州的一个大型免疫中心招募了总共160名PLHIV（N = 160）。参与者报告了交通经历、交通易损性和居住情况。使用Mantel-Haenszel卡方检验比较了出行时间组（从居住地点到艾滋病毒诊所<15分钟、15 - 30分钟和>30分钟）在社会人口统计学特征、交通易损性和艾滋病毒护理中断方面的差异。多变量逻辑回归检验了我们的先验假设，即出行时间将预测艾滋病毒护理中断。
大多数参与者年龄在45 - 64岁之间（54.4%），单身（77.0%），男性（63.8%），黑人（77.5%）。近20%的参与者居住在距离艾滋病毒诊所<15分钟的地方，59.1%居住在15 - 30分钟的地方，21.4%居住在>30分钟的地方。前往艾滋病毒护理机构需出行>30分钟的PLHIV比居住在距离<15分钟的人更有可能报告交通易损性（73.5%对51.6%，p = 0.048）、错过艾滋病毒护理预约（64.7%对41.9%，p = 0.049）以及因交通问题无法就诊（67.7%对39.4%；p = 0.014）。调整后的优势比（AOR）表明，需出行>30分钟的PLHIV更有可能经历与交通相关的艾滋病毒护理中断，包括预约迟到（AOR 5.25，95%置信区间：1.06 - 25.92）、错过预约（AOR 3.85，95%置信区间：1.04 - 15.89）以及无法就诊（AOR 7.06，95%置信区间：0.59 - 14.89）。
在南卡罗来纳州这个艾滋病毒负担过重的南部农村州，前往艾滋病毒护理机构的长途出行时间（>30分钟）与护理中断相关，包括更多的就诊错过。迫切需要交通干预措施以及其他扩大农村地区艾滋病毒护理可及性的努力，以确保所有PLHIV能够持续接受艾滋病毒护理，从而实现并维持病毒抑制。
