Impact of Travel Distance and Transportation Needs on Racial/Ethnic Differences in Achieving Sustained Viral Suppression in Miami-Dade County, 2017.

Travel distance to receive HIV services and lack of reliable means of transportation may present a barrier to service utilization and influence HIV care outcomes. This study examined the moderating effect of travel distance and transportation needs to HIV medical case management (MCM) sites and AIDS Drug Assistance Program (ADAP) pharmacies on the association between race/ethnicity and sustained viral suppression. Data were obtained from the Miami-Dade County Ryan White Program, the American Community Survey, and Simply Analytics. Distance from the residences of the Ryan White clients to MCM sites and ADAP pharmacies were first calculated using the Network Analyst Tool within ArcGIS. We conducted multilevel logistic regression models to assess the role of transportation and travel distance on the association between race/ethnicity and sustained viral suppression. Most clients (88.9%) did not use the nearest MCM facilities to their residence. Among clients who did not have access to transportation (both public and personal), the odds of achieving sustained viral load suppression were lower for non-Hispanic Blacks (NHB) (adjusted odds ratio:0.28; 95% confidence interval:0.10-0.76), Hispanics (0.35; 0.13-0.94), and Haitians (0.16; 0.05-0.52) compared to non-Hispanic Whites. Also, Haitians and NHB had poor sustained viral suppression across other travel-related variables, including travel to the nearest facility of care, median travel distances to clients' MCM site of choice, and median travel distance to the nearest ADAP pharmacy. Findings indicate that lack of access to transportation exacerbates racial/ethnic disparities in sustained viral suppression. Hence, it is important to address transportation needs and understand why clients obtain care from MCM sites that are not closest to their residence.