title: Travel for HIV care in England: a choice or a necessity?
abstract: OBJECTIVE
  The aims of the study were (1) to measure the distance required to travel, and the distance actually travelled, to HIV services by HIV-infected adults, and (2) to calculate the proportion of patients who travelled beyond local services and identify socio-demographic and clinical predictors of use of non-local services.
  
  
  METHODS
  The straight-line distance between a patient's residence and HIV services was determined for HIV-infected patients in England in 2007. 'Local services' were defined as the closest HIV service to a patient's residence and other services within an additional 5 km radius. Multivariable logistic regression was used to identify socio-demographic and clinical predictors of accessing non-local services.
  
  
  RESULTS
  In 2007, nearly 57 000 adults with diagnosed HIV infection accessed HIV services in England; 42% lived in the most deprived areas. Overall, 81% of patients lived within 5 km of a service, and 8.7% used their closest HIV service. The median distance to the closest HIV service was 2.5 km [interquartile range (IQR) 1.5-4.2 km] and the median actual distance travelled was 4.8 km (IQR 2.5-9.7 km). A quarter of patients used a 'non-local' service. Patients living in the least deprived areas were twice as likely to use non-local services as those living in the most deprived areas [adjusted odds ratio (AOR) 2.16; 95% confidence interval (CI) 1.98-2.37]. Other predictors for accessing non-local services included living in an urban area (AOR 0.77; 95% CI 0.69-0.85) and being diagnosed more than 12 months (AOR 1.48; 95% CI 1.38-1.59).
  
  
  CONCLUSIONS
  In England, 81% of HIV-infected patients live within 5 km of HIV services and a quarter of HIV-infected adults travel to non-local HIV services. Those living in deprived areas are less likely to travel to non-local services.
authors.affiliation: Health Protection Agency Centre for Infections, London, UK. susan.huntington.09@ucl.ac.uk
authors.forename: S
authors.initials: S
authors.lastname: Huntington
authors.forename: T
authors.initials: T
authors.lastname: Chadborn
authors.forename: B D
authors.initials: BD
authors.lastname: Rice
authors.forename: A E
authors.initials: AE
authors.lastname: Brown
authors.forename: V C
authors.initials: VC
authors.lastname: Delpech
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D016001:Confidence Intervals; D004739:England / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000628:therapy; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012959:Socioeconomic Factors; D014195:Travel / Q000191:economics / Q000706:statistics & numerical data*; D055815:Young Adult