People Living with HIV Travel Farther to Access Healthcare: A Population-Based Geographic Analysis from Rural Uganda
INTRODUCTION:
The
availability of specialized HIV services
is limited in rural areas of sub-Saharan Africa where the need is the greatest.
Where HIV services
are available, people living with HIV (PLHIV)
must overcome large geographic, economic and social barriers
to access healthcare. The objective of this study was to understand the unique
barriers PLHIV face when accessing healthcare compared with those not living
with HIV in a rural area of sub-Saharan Africa with
limited availability of healthcare infrastructure.
METHODS:
We
conducted a population-based cross-sectional study of 447 heads of household on
Bugala Island, Uganda. Multiple linear
regression models were used to compare travel time, cost and distance to access
healthcare, and log binomial models were used to test for associations between HIV status and access to nearby health services.
RESULTS:
PLHIV
traveled an additional 1.9 km to access
healthcare compared with those not living with HIV, and they
were 56% less likely to access healthcare at the nearest health facility to
their residence, so long as that facility lacked antiretroviral therapy (ART)
services. We found no evidence that PLHIV traveled further for care if the
nearest facility supplies ART services. Among those who reported uptake of care at one of two facilities on
the island that provides ART (81% of PLHIV and 68% of HIV-negative
individuals), PLHIV tended to seek care at a higher tiered facility that
provides ART, even when this facility was not their closest facility (30% of
PLHIV traveled further than the closest ART facility compared with 16% of HIV-negative
individuals), and traveled an additional 2.2 km to access that
facility, relative to HIV-negative individuals. Among PLHIV, residential distance was associated with access to
facilities providing ART, comparing
residential distances of 3-5 km to 0-2 km
CONCLUSIONS:
PLHIV
travel longer distances for care, a phenomenon that may be driven by both the
limited availability of specialized HIV services and preference for higher tiered
facilities.
Below: Spatial distribution of 447 heads of household and seven official health facilities surveyed (ART services indicated) on the northern portion of Bugala Island, Uganda
- 1Institute for Disease Modeling, Bellevue, WA, USA; aakullian@intven.com.
- 2Department of Epidemiology and Biostatistics, School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.
- 3Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, WA, USA.
- 4Global Medicines Program, Department of Global Health, University of Washington, Seattle, WA, USA.
- J Int AIDS Soc. 2016 Feb 10;19(1):20171. doi: 10.7448/IAS.19.1.20171. eCollection 2016
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