Evaluating the relationship between driving commute time and distance to HIV testing sites and late HIV diagnosis in Atlanta, Georgia Público

Abstract

Ending the HIV epidemic in the United States is dependent on early diagnosis, prompt linkage to care, and viral load suppression which benefits the individual and decreases the risk of HIV transmission. While long commute time and distance to HIV services have been shown to be barriers to accessing HIV services, there is limited research assessing the effects of commute time and distance to HIV testing on late HIV diagnoses in metropolitan areas. The goal of this thesis was to evaluate the relationships between driving commute time and distance to HIV testing locations and late HIV diagnoses in Atlanta, Georgia. Data from 2013-2018 on late HIV diagnoses in Atlanta, defined as individuals 13 years and older diagnosed with stage 3 HIV within 3 months of initial HIV diagnoses, were accessed through AIDSVu. The driving commute time and distance from a geometric centroid of each Atlanta zip code tabulation area (ZCTA) to the nearest HIV testing location were calculated on ArcGIS Online. Descriptive analyses and choropleth maps were used to describe the driving commute time and distance to HIV testing locations and late HIV diagnoses across ZCTAs. Unadjusted and adjusted linear regression was used to assess the associations between driving commute time and distance to HIV testing locations and late HIV diagnoses across ZCTAs. In adjusted analyses, poverty was selected as a covariate. Additionally, linear regression was performed after stratifying the dataset by poverty. Across the 99 ZCTAs included in the analysis, there were 101 HIV testing locations and the mean percentage of late HIV diagnoses was 23%. The mean distance was 4.14 miles and the mean driving commute time was 8.26 minutes. Driving commute time to HIV testing locations was not associated with late HIV diagnoses in unadjusted and adjusted models. Poverty confounded the relationship between driving distance to HIV testing locations and late HIV diagnoses. Driving commute time and distance to HIV testing locations were not significantly associated with late HIV diagnoses in Atlanta, Georgia. This analysis suggests the importance of examining socioeconomic factors when observing spatial relationships between HIV testing services and HIV-related outcomes.

Table of Contents

INTRODUCTION 1

METHODS 4

Data sources 4

Key variables 4

Data analysis 5

RESULTS 6

DISCUSSION 10

REFERENCES 14

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	HIV, GIS, late HIV diagnosis, commute time, driving distance
Committee Chair / Thesis Advisor	Patrick Sullivan, Emory University
Committee Members	Michael Kramer, Emory University

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