title: Influence of socio-demographic factors on distances travelled to access HIV services: enhanced surveillance of HIV patients in north west England.
abstract: BACKGROUND
  Patient choice and access to health care is compromised by many barriers including travel distance. Individuals with the human immunodeficiency virus (HIV) can seek free specialist care in Britain, without a referral, providing flexible access to care services. Willingness to travel beyond local services for preferred care has funding and service implications. Data from an enhanced HIV surveillance system were used to explore geodemographic and clinical factors associated with accessing treatment services.
  
  
  METHODS
  We extracted data on the location, type and frequency of care services utilized by HIV positive persons (n = 3983) accessing treatment in north west England between January 1st 2005 and June 30th 2006. Individuals were allocated a deprivation score and grouped by urban/rural residence, and distance to care services was calculated. Analysis identified independent predictors of distance travelled (general linear modelling) and, for those bypassing their nearest clinic, the probability of accessing a specialist service (logistic regression, SPSS ver 14). Inter-relationships between variables and distance travelled were visualised using detrended correspondence analysis (PC-ORD ver 4.1).
  
  
  RESULTS
  HIV infected persons travelled an average of 4.8 km (95% confidence intervals (CI) 4.6-4.9) per trip and had on average 6 visits (95% CI 5.9-6.2) annually for care. Longer trips were made by males (4.8 km vs 4.5 km), white people (6.2 km), the young (>15 years, 6.8 km) and elderly (60+ years, 6.3 km), those on multiple therapy (5.3 km vs 4.0 km), and the more affluent living in rural areas (16.1 km, P < 0.05). Half the individuals bypassed their nearest clinic to visit a more distant facility, and this was associated with being aged under 20 years, multiple therapy, being a male infected by sex between men, relative wealth, and living in rural areas (P < 0.05). Of those bypassing local facilities, poorer people were more likely to access a specialist centre but did not have as far to travel to do so (3.6 km) compared to those from less deprived areas (8.6 km).
  
  
  CONCLUSIONS
  Distance travelled, and type of HIV services used, were associated with socioeconomic status, even after accounting for ethnicity, route of infection and age. Thus despite offering an 'equitable' service, travel costs may advantage those with higher income.
authors.affiliation: Centre for Public Health, Liverpool John Moores University, Liverpool, UK. p.a.cook@ljmu.ac.uk
authors.forename: Penny A
authors.initials: PA
authors.lastname: Cook
authors.forename: Jennifer
authors.initials: J
authors.lastname: Downing
authors.forename: C Philip
authors.initials: CP
authors.lastname: Wheater
authors.forename: Mark A
authors.initials: MA
authors.lastname: Bellis
authors.forename: Karen
authors.initials: K
authors.lastname: Tocque
authors.forename: Qutub
authors.initials: Q
authors.lastname: Syed
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D016001:Confidence Intervals; D004739:England; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D012959:Socioeconomic Factors; D014195:Travel / Q000191:economics* / Q000706:statistics & numerical data; D055815:Young Adult