title: Development of a comprehensive measure of spatial access to HIV provider services, with application to Atlanta, Georgia.
abstract: BACKGROUND
  No existing measures of HIV care access consider both spatial proximity to services and provider-related characteristics in a single measure. We developed and applied a tool to: (1) quantify spatial access to HIV care services (supply) and (2) identify underserved areas with respect to HIV cases (demand), by travel mode, in Atlanta.
  
  
  METHODS
  Building on a study of HIV care engagement, data from an HIV care provider database, and HIV case counts by zip code tabulation area (ZCTA) from AIDSVu.org, we fit a discrete choice model to estimate practice characteristics most salient in defining patient care access. Modified spatial gravity modeling quantified supply access based on discrete choice model results separately for travel by car and by public transportation. Relative access scores were calculated by ZCTA, and underserved areas (defined as having low supply access and high HIV case count) were identified for each travel mode.
  
  
  RESULTS
  Characteristics retained in the final model included: travel distance, available provider-hours, availability of ancillary services, and whether Ryan White patients were accepted. HIV provider supply was higher in urban versus suburban/rural areas for both travel modes, with lower supply access if traveling by public transportation. Underserved areas were concentrated in south and east Atlanta if traveling by public transportation, overlapping with many areas of high poverty. Approximately 7.7 %, if traveling by car, and 64.3 %, if traveling by public transportation, of Atlanta-based persons with diagnosed HIV infection resided in underserved areas.
  
  
  CONCLUSIONS
  These findings highlight underserved areas in south and east Atlanta if traveling by public transit. Conceptualizing access to medical services spatially and by travel mode may help bridge gaps between patient needs and service availability and improve HIV outcomes.
authors.affiliation: Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA ; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA.
authors.forename: Sharoda
authors.identifier: 0000-0002-8503-4116
authors.initials: S
authors.lastname: Dasgupta
authors.affiliation: Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA ; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA.
authors.forename: Michael R
authors.identifier: 0000-0002-6372-6170
authors.initials: MR
authors.lastname: Kramer
authors.affiliation: Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA ; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA.
authors.forename: Eli S
authors.identifier: 0000-0002-1695-8075
authors.initials: ES
authors.lastname: Rosenberg
authors.affiliation: Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA ; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA.
authors.forename: Travis H
authors.identifier: 0000-0003-1133-4762
authors.initials: TH
authors.lastname: Sanchez
authors.affiliation: Laney Graduate School, Emory University, Mailstop 1000-001-1AF, 209 Administration Building, 201 Dowman Drive, Atlanta, GA 30322 USA ; Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA 30329 USA.
authors.forename: Patrick S
authors.identifier: 0000-0002-7728-0587
authors.initials: PS
authors.lastname: Sullivan
keywords: HIV; Healthcare services; Spatial access; Travel mode