Geographic Access to HIV Care

Over one million Americans are currently living with HIV. The Ryan White HIV/AIDS Program (RWHAP) provides funding for HIV medical care and medications for people living with HIV. The RWHAP program received 2.34 billion dollars in 2018 and the Ending the HIV Epidemic initiative was awarded 117 million dollars in 2020. However, even with increased funding, geographic barriers to accessing HIV care can prevent people from obtaining treatment. Additionally, the impact of insurance status (none, Medicaid, Affordable Care Act plans) on drive times to HIV care is not well understood. Geographic access to RWHAP clinics in the contiguous United States was examined. Using spatial analysis techniques, the duration of drive time from the center of every county equivalent to the nearest accessible RWHAP clinic was measured. Counties were characterized in terms of social determinants of health and HIVrelated variables and their associations with access to HIV care were examined.The effect of insurance status on drive times was analyzed in order to measure its impact by being uninsured, enrolled in Medicaid, or enrolled in either the least or most expensive Affordable Care Act plans.Four hundred twenty-seven RWHAP locations were identified with a median county-level drive time of 64.6 minutes (interquartile range (IQR) 40.9-97.9) for counties with five or more diagnosed HIV cases. The median drive time for Medicaid access was 69.3 minutes (IQR 42.2-106.0), with some states impacted more than others. These findings were used to make specific policy recommendations to improve access and reduce barriers to HIV care.