Evidence Strategies and Practical tools for inclusion of social and structural interventions such as housing, employment, and food security in plans to end the epidemic
Abstract Format : Research suggests that lack of transportation access is a barrier to retention in HIV care for persons living with HIV (PLWH). The Ryan White HIV/AIDS Program (RW) provides support services, including transportation, to low income and underinsured PLWH. This analysis evaluates retention in HIV care based on the receipt and level of transportation services for RW clients in Virginia.
Methods : Of the 12,717 clients who received services through Virginia’s RW Part A-D funding between January 1, 2013 and December 31, 2016, 3,424 (27%) received transportation services. Of those, 61% (N=2,095) received three or more transportation services. Retention in HIV care was defined as having two or more care markers (CD4 or viral load lab, HIV medical visit, or antiretroviral prescription) in a 12-month time period. Backward elimination multivariate logistic regression was used to determine if there was a predictive relationship between receipt and level of transportation service and retention in HIV care.
Results : From 2013 to 2016, RW clients who received at least one transportation service were more likely to be retained in care than clients who did not receive a transportation service [2013 odds ratio (OR): 1.7, 95% confidence interval (CI), (1.4, 2.2); 2014 OR: 1.6 (1.3, 2.0); 2015 OR: 1.99 (1.6, 2.5); 2016 OR: 1.7 (1.4, 2.2)]. Clients who received three or more transportation services were more likely to be retained in care than those who did not receive any transportation services [2013 OR: 2.7 (1.8, 3.9); 2014 OR: 2.2 (1.5, 3.2); 2015 OR: 2.4 (1.8, 3.3); 2016 OR: 2.5 (1.7, 3.5)].
Conclusions : Results suggest that RW clients who accessed transportation services were more likely to be retained in care, and receipt of three or more transportation services may facilitate greater retention. These findings strengthen evidence that interventions addressing transportation access may improve continuous engagement in care for PLWH in Virginia.