Distance to testing sites and its association with timing of HIV diagnosis^*

* Results were presented at the Society for Epidemiologic Research Annual Meeting, Denver, CO 16–19 June 2015. All research was conducted at the University of North Carolina at Chapel Hill.

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.

KEYWORDS:

• Recent HIV infection
• surveillance
• HIV testing
• geographic distance
• barriers to testing
• late diagnosis

Acknowledgements

The authors would like to acknowledge members of the Communicable Disease Branch at the North Carolina Department of Health and Human Services, particularly Lynne Sampson, John Barnhart, Erika Samoff, Del Williams, Janet Alexander and Jason Maxwell for providing access to and expertise about the data used in this analysis. Additionally, the authors greatly appreciate the scientific support provided by Brian Pence in the design of this study.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Anna B. Cope http://orcid.org/0000-0001-7599-196X

Notes

* Results were presented at the Society for Epidemiologic Research Annual Meeting, Denver, CO 16–19 June 2015. All research was conducted at the University of North Carolina at Chapel Hill.

Additional information

Funding

This work was supported by the National Institutes of Health [grant numbers KL2 TR001109, 5 T32AI07001-36, and R24 HD050924] and an administrative supplement to the UNC Center for AIDS Research [grant number P30 AI050410].