Alpha Omega Alpha Honor Medical Society

Drive Time to Care Does Not Alter HIV Outcomes in Kentucky

Investigator: Brad St. Martin

Mentors: Moises Huaman Joo, MD, MSc; Alice Thornton, MD

Background:
The effects of drive time to care on clinical outcomes for persons newly diagnosed with HIV infection have not been well established.

Methods:
A retrospective cohort study was conducted to analyze all adults newly diagnosed with HIV who presented to the University of Kentucky Bluegrass Care Clinic between 2007 and 2012. Using electronic medical records, we analyzed whether living ≥45 minutes from care was associated with late HIV presentation (CD4<200 cells/ml within 90 days of diagnosis), and both HIV viral load suppression (viral load<50 copies/ml) and CD4 count at one year after diagnosis. Driving time to care was calculated using Google Maps and SAS.

Results:
Data from 393 newly diagnosed HIV patients were included. The median driving time to care was 17 minutes (IQR, 10–59), and 29% traveled≥45 minutes. At time of diagnosis, late HIV presentation did not significantly differ with increased driving time to care (36% vs. 39%, P=0.63). In multivariable analysis, driving time≥45 minutes was associated with a non-significant 17.5 point increase in final CD4 count (P=0.37). Drive time was not associated with viral load suppression (Adjusted OR, 1.22; 95% CI, 0.75–2.00) at one year.

Conclusion:
Within this Kentucky population, drive time to care did not have an impact on late HIV presentation, CD4 count at one year or viral suppression at one year. The provision of transportation assistance, patient desire to access a distant clinic to ensure confidentiality, and other factors may have reduced potential negative effects of driving time in this population.

Last modified: 2/01/2017

Updated on February 3, 2017.


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