Impact of geographic and transportation-related barriers on HIV outcomes in sub-saharan Africa: A systematic review

Alexander J. Lankowski, Mark J. Siedner, David R. Bangsberg, Alexander C. Tsai

Research output: Contribution to journalReview article

83 Scopus citations

Abstract

Difficulty obtaining reliable transportation to clinic is frequently cited as a barrier to HIV care in sub-Saharan Africa (SSA). Numerous studies have sought to characterize the impact of geographic and transportation-related barriers on HIV outcomes in SSA, but to date there has been no systematic attempt to summarize these findings. In this systematic review, we summarized this body of literature. We searched for studies conducted in SSA examining the following outcomes in the HIV care continuum: (1) voluntary counseling and testing, (2) pre-antiretroviral therapy (ART) linkage to care, (3) loss to follow-up and mortality, and (4) ART adherence and/or viral suppression. We identified 34 studies containing 52 unique estimates of association between a geographic or transportation-related barrier and an HIV outcome. There was an inverse effect in 23 estimates (44 %), a null association in 26 (50 %), and a paradoxical beneficial impact in 3 (6 %). We conclude that geographic and transportation-related barriers are associated with poor outcomes across the continuum of HIV care.

Original languageEnglish (US)
Pages (from-to)1199-1223
Number of pages25
JournalAIDS and Behavior
Volume18
Issue number7
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • Adherence
  • Linkage to care
  • Retention in care
  • Sub-Saharan Africa
  • Transportation barriers

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

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