title: The Effect of Commuting Patterns on HIV Care Attendance Among Men Who Have Sex With Men (MSM) in Atlanta, Georgia.
abstract: BACKGROUND
  Travel-related barriers to human immunodeficiency virus (HIV) care, such as commute time and mode of transportation, have been reported in the United States.
  
  
  OBJECTIVE
  The objective of the study was to investigate the association between public transportation use and HIV care attendance among a convenience sample of Atlanta-based, HIV-positive men who have sex with men (MSM), evaluate differences across regions of residence, and estimate the relationship between travel distance and time by mode of transportation taken to attend appointments.
  
  
  METHODS
  We used Poisson regression to estimate the association between use of public transportation to attend HIV-related medical visits and frequency of care attendance over the previous 12 months. The relationship between travel distance and commute time was estimated using linear regression. Kriging was used to interpolate commute time to visually examine geographic differences in commuting patterns in relation to access to public transportation and population-based estimates of household vehicle ownership.
  
  
  RESULTS
  Using public transportation was associated with lower rates of HIV care attendance compared to using private transportation, but only in south Atlanta (south: aRR: 0.75, 95% CI 0.56, 1.0, north: aRR: 0.90, 95% CI 0.71, 1.1). Participants living in south Atlanta were more likely to have longer commute times associated with attending HIV visits, have greater access to public transportation, and may live in areas with low vehicle ownership. A majority of attended HIV providers were located in north and central Atlanta, despite there being participants living all across the city. Estimated commute times per mile traveled were three times as high among public transit users compared to private transportation users.
  
  
  CONCLUSIONS
  Improving local public transit and implementing use of mobile clinics could help address travel-related barriers to HIV care.
authors.affiliation: Emory University Atlanta, GA United States.
authors.forename: Sharoda
authors.identifier: 0000-0002-5459-9210
authors.initials: S
authors.lastname: Dasgupta
authors.affiliation: Emory University Atlanta, GA United States.
authors.forename: Michael R
authors.identifier: 0000-0002-6372-6170
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Emory University Atlanta, GA United States.
authors.forename: Eli S
authors.identifier: 0000-0002-1695-8075
authors.initials: ES
authors.lastname: Rosenberg
authors.affiliation: Emory University Atlanta, GA United States.
authors.forename: Travis H
authors.identifier: 0000-0003-1133-4762
authors.initials: TH
authors.lastname: Sanchez
authors.affiliation: Atlanta Regional Commission Atlanta, GA United States.
authors.forename: Landon
authors.identifier: 0000-0001-5212-0395
authors.initials: L
authors.lastname: Reed
authors.affiliation: Emory University Atlanta, GA United States.
authors.forename: Patrick S
authors.identifier: 0000-0002-7728-0587
authors.initials: PS
authors.lastname: Sullivan
keywords: HIV care; commuting patterns; men who have sex with men; public transportation