GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda

Mark J. Siedner, Alexander Lankowski, Alexander C. Tsai, Conrad Muzoora, Jeffrey N. Martin, Peter W. Hunt, Jessica E. Haberer, David Bangsberg

Research output: Contribution to journalArticle

59 Citations (Scopus)

Abstract

Objective: Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects, possibly because a reliable, validated measure of transportation barriers has not been identified. Design: Prospective cohort study of HIV-infected patients in rural Uganda. Methods: Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara, Uganda as part of the Uganda AIDS Rural Treatment Outcomes (UARTO) Study. We collected the following measures of transportation barriers to HIV clinic: global positioning systems (GPS)-tracked distance measured by driving participants to their homes along their typical route; straight-line GPS distance from clinic to home, calculated with the Great Circle Formula; self-reported travel time; and self-reported travel cost. We assessed inter-measure agreement using linear regression, correlation coefficients and K statistics (by measure quartile) and validated measures by fitting linear regression models to estimate associations with days late for clinic visits. Results: One hundred and eighty-eight participants were tracked with GPS. Seventy-six percent were women, with a median age of 40 years and median CD4 cell count of 193 cells/μl. We found a high correlation between GPS-based distance measures (β = 0.74, P<0.001, R2 = 0.92, K = 0.73), but little correlation between GPS-based and self-reported measures (all R2<0.4). GPS-based measures were associated with days late to clinic (P<0.001); but neither self-reported measure was associated (P> 0.85). Conclusion: GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural, resource-limited settings.

Original languageEnglish (US)
Pages (from-to)1503-1508
Number of pages6
JournalAIDS
Volume27
Issue number9
DOIs
StatePublished - Jun 1 2013
Externally publishedYes

Fingerprint

Geographic Information Systems
Uganda
Ambulatory Care
HIV
Linear Models
Absenteeism
CD4 Lymphocyte Count
Patient Care
Acquired Immunodeficiency Syndrome
Cohort Studies
Referral and Consultation
Outcome Assessment (Health Care)
Prospective Studies
Costs and Cost Analysis
Health

Keywords

  • Distance to clinic
  • Global positioning systems
  • HIV/AIDS
  • Linkage to care
  • Sub-Saharan Africa
  • Transportation
  • Uganda

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Infectious Diseases

Cite this

GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. / Siedner, Mark J.; Lankowski, Alexander; Tsai, Alexander C.; Muzoora, Conrad; Martin, Jeffrey N.; Hunt, Peter W.; Haberer, Jessica E.; Bangsberg, David.

In: AIDS, Vol. 27, No. 9, 01.06.2013, p. 1503-1508.

Research output: Contribution to journalArticle

Siedner, Mark J. ; Lankowski, Alexander ; Tsai, Alexander C. ; Muzoora, Conrad ; Martin, Jeffrey N. ; Hunt, Peter W. ; Haberer, Jessica E. ; Bangsberg, David. / GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda. In: AIDS. 2013 ; Vol. 27, No. 9. pp. 1503-1508.
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T1 - GPS-measured distance to clinic, but not self-reported transportation factors, are associated with missed HIV clinic visits in rural Uganda

AU - Siedner, Mark J.

AU - Lankowski, Alexander

AU - Tsai, Alexander C.

AU - Muzoora, Conrad

AU - Martin, Jeffrey N.

AU - Hunt, Peter W.

AU - Haberer, Jessica E.

AU - Bangsberg, David

PY - 2013/6/1

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N2 - Objective: Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects, possibly because a reliable, validated measure of transportation barriers has not been identified. Design: Prospective cohort study of HIV-infected patients in rural Uganda. Methods: Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara, Uganda as part of the Uganda AIDS Rural Treatment Outcomes (UARTO) Study. We collected the following measures of transportation barriers to HIV clinic: global positioning systems (GPS)-tracked distance measured by driving participants to their homes along their typical route; straight-line GPS distance from clinic to home, calculated with the Great Circle Formula; self-reported travel time; and self-reported travel cost. We assessed inter-measure agreement using linear regression, correlation coefficients and K statistics (by measure quartile) and validated measures by fitting linear regression models to estimate associations with days late for clinic visits. Results: One hundred and eighty-eight participants were tracked with GPS. Seventy-six percent were women, with a median age of 40 years and median CD4 cell count of 193 cells/μl. We found a high correlation between GPS-based distance measures (β = 0.74, P<0.001, R2 = 0.92, K = 0.73), but little correlation between GPS-based and self-reported measures (all R2<0.4). GPS-based measures were associated with days late to clinic (P<0.001); but neither self-reported measure was associated (P> 0.85). Conclusion: GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural, resource-limited settings.

AB - Objective: Studies of the association between transportation barriers and HIV-related health outcomes have shown both positive and negative effects, possibly because a reliable, validated measure of transportation barriers has not been identified. Design: Prospective cohort study of HIV-infected patients in rural Uganda. Methods: Participants were enrolled from the HIV clinic at the regional referral hospital in Mbarara, Uganda as part of the Uganda AIDS Rural Treatment Outcomes (UARTO) Study. We collected the following measures of transportation barriers to HIV clinic: global positioning systems (GPS)-tracked distance measured by driving participants to their homes along their typical route; straight-line GPS distance from clinic to home, calculated with the Great Circle Formula; self-reported travel time; and self-reported travel cost. We assessed inter-measure agreement using linear regression, correlation coefficients and K statistics (by measure quartile) and validated measures by fitting linear regression models to estimate associations with days late for clinic visits. Results: One hundred and eighty-eight participants were tracked with GPS. Seventy-six percent were women, with a median age of 40 years and median CD4 cell count of 193 cells/μl. We found a high correlation between GPS-based distance measures (β = 0.74, P<0.001, R2 = 0.92, K = 0.73), but little correlation between GPS-based and self-reported measures (all R2<0.4). GPS-based measures were associated with days late to clinic (P<0.001); but neither self-reported measure was associated (P> 0.85). Conclusion: GPS-measured distance to clinic is associated with HIV clinic absenteeism and should be prioritized over self-reported measures to optimally risk-stratify patients accessing care in rural, resource-limited settings.

KW - Distance to clinic

KW - Global positioning systems

KW - HIV/AIDS

KW - Linkage to care

KW - Sub-Saharan Africa

KW - Transportation

KW - Uganda

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