Examining transportation as a barrier to service utilization for PLWHA

Background: Research indicates people living with HIV/AIDS (PLWHA) with unmet transportation needs are less likely to access HIV-related primary care visits and ancillary services. Although recognized as a barrier to service utilization, the complexity of transportation dynamics warranted additional study, as unique issues present for urban versus rural consumers, and those with or without access to personal vehicles. Methods: This study combined qualitative (3 focus groups and 15 interviews with consumers, service providers, and transportation providers) and quantitative (4 page survey, N=309 PLWHA) methods to gain an understanding of how transportation impacts the capacity of PLWHA with respect to accessing primary and ancillary health-related services in a sample of rural and urban PLWHA. Results: Participants who relied on public transportation to get to HIV-related services faced more challenges than those with their own car. They were more likely to report that delays in transportation caused them to be late or miss their appointments, and there were services they were unable to access due to insufficient transportation. In addition, transportation problems compromised adherence to HIV-related treatment plans, including difficulty filling prescriptions and maintaining a stable medical home. Conclusions: Transportation is critical to medical adherence for PLWHA. Consumers who live in rural areas are disadvantaged due to limited transportation options, whereas urban consumers face challenges with insufficient transportation infrastructure. As a result, consumers are piecing together complex transportation strategies, relying on multiple sources, which may not always be dependable. Recommendations related to ameliorating transportation barriers to HIV-related medical adherence will be discussed.