title: Distance to testing sites and its association with timing of HIV diagnosis.
abstract: Early HIV diagnosis enables prompt treatment initiation, thereby contributing to decreased morbidity, mortality, and transmission. We aimed to describe the association between distance from residence to testing sites and HIV disease stage at diagnosis. Using HIV surveillance data, we identified all new HIV diagnoses made at publicly funded testing sites in central North Carolina during 2005-2013. Early-stage HIV was defined as acute HIV (antibody-negative test with a positive HIV RNA) or recent HIV (normalized optical density <0.8 on the BED assay for non-AIDS cases); remaining diagnoses were considered post-early-stage HIV. Street distance between residence at diagnosis and (1) the closest testing site and (2) the diagnosis site was dichotomized at 5 miles. We fit log-binomial models using generalized estimating equations to estimate prevalence ratios (PR) and robust 95% confidence intervals (CI) for post-early-stage diagnoses by distance. Models were adjusted for race/ethnicity and testing period. Most of the 3028 new diagnoses were black (N = 2144; 70.8%), men who have sex with men (N = 1685; 55.7%), and post-early-stage HIV diagnoses (N = 2010; 66.4%). Overall, 1145 (37.8%) cases traveled <5 miles for a diagnosis. Among cases traveling ≥5 miles for a diagnosis, 1273 (67.6%) lived <5 miles from a different site. Residing ≥5 miles from a testing site was not associated with post-early-stage HIV (adjusted PR, 95% CI: 0.98, 0.92-1.04), but traveling ≥5 miles for a diagnosis was associated with higher post-early HIV prevalence (1.07, 1.02-1.13). Most of the elevated prevalence observed in cases traveling ≥5 miles for a diagnosis occurred among those living <5 miles from a different site (1.09, 1.03-1.16). Modest increases in post-early-stage HIV diagnosis were apparent among persons living near a site, but choosing to travel longer distances to test. Understanding reasons for increased travel distances could improve accessibility and acceptability of HIV services and increase early diagnosis rates.
authors.affiliation: a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.|b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Anna B
authors.initials: AB
authors.lastname: Cope
authors.affiliation: a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Powers
authors.affiliation: c Department of Environmental Sciences and Engineering , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Marc L
authors.initials: ML
authors.lastname: Serre
authors.affiliation: d Department of Obstetrics and Gynecology , University of Chicago , Chicago , IL , USA.
authors.forename: Veronica
authors.initials: V
authors.lastname: Escamilla
authors.affiliation: a Department of Epidemiology , University of North Carolina , Chapel Hill , NC , USA.|e Department of Geography , University of North Carolina , Chapel Hill , NC , USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Emch
authors.affiliation: b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Leone
authors.affiliation: f North Carolina Department of Health and Human Services , Raleigh , NC , USA.
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Mobley
authors.affiliation: b Division of Infectious Diseases , School of Medicine, University of North Carolina at Chapel Hill , Chapel Hill , NC , USA.
authors.forename: William C
authors.initials: WC
authors.lastname: Miller
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D057210:Delayed Diagnosis; D042241:Early Diagnosis; D005260:Female; D006678:HIV / Q000302:isolation & purification*; D015658:HIV Infections / Q000175:diagnosis* / Q000821:virology; D006297:Health Services Accessibility; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009657:North Carolina; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D012367:RNA, Viral / Q000097:blood*; D013997:Time Factors; D055815:Young Adult
chemical_list: D012367:RNA, Viral
keywords: HIV testing; Recent HIV infection; barriers to testing; geographic distance; late diagnosis; surveillance