title: Travel distance to HIV medical care: a geographic analysis of weighted survey data from the Medical Monitoring Project in Philadelphia, PA.
abstract: Decisions regarding where patients access HIV care are not well understood. The purpose of this analysis was to examine differences in travel distance to care among persons receiving care in Philadelphia. A multi-stage sampling design was utilized to identify 400 potential participants. 65 % (260/400) agreed to be interviewed. Participants were asked questions about medical care, supportive services, and geographic location. Distances were calculated between residence and care location. 46.3 % travelled more than three miles beyond the nearest facility. Uninsured travelled further (6.9 miles, 95 % CI 3.9-9.8) than persons with public insurance (3.3 miles, 2.9-3.6). In multivariate analyses, no insurance (20/260) was associated with increased distance (p = 0.0005) and Hispanic ethnicity was associated with decreased distance (p = 0.0462). Persons without insurance travel further but insurance status alone does not explain the variability in distance travelled to care. In Philadelphia, Hispanic populations, and providers that may be most accessible to them, are spatially contained.
authors.affiliation: AIDS Activities Coordinating Office, Philadelphia Department of Public Health, 1101 Market Street, 8th Floor, Philadelphia, PA, 19107, USA, michael.eberhart@phila.gov.
authors.forename: M G
authors.initials: MG
authors.lastname: Eberhart
authors.forename: C D
authors.initials: CD
authors.lastname: Voytek
authors.forename: A
authors.initials: A
authors.lastname: Hillier
authors.forename: D S
authors.initials: DS
authors.lastname: Metzger
authors.forename: M B
authors.initials: MB
authors.lastname: Blank
authors.forename: K A
authors.initials: KA
authors.lastname: Brady
mesh_terms: D000328:Adult; D000367:Age Factors; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000191:economics / Q000453:epidemiology*; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D015143:Philadelphia / Q000453:epidemiology; D011159:Population Surveillance; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014195:Travel