Unsuppressed Viral Loads and Public Transport

Background: Newly diagnosed HIV cases with unsuppressed viral load are a chief public health concern for governmental agencies. To help achieve viral suppression within 6 months of diagnosis, analysis of structural interventions are integral. Here we investigate the relationship between proximity of providers by public transportation to the directional trend in viral load. We then investigate how this is related to frequency of visits.

Methods: In this analysis, a sample newly diagnosed cases (n=872) in 2009 are followed in 2010 through surveillance data. Cases with unsuppressed viral loads (n=82) were evaluated with descriptive and bivariate analysis. To evaluate the effect of distance, logistic regression was used to model change in viral suppression and frequency of care visits by distance from provider to the metro, controlling for race, mode of transmission, and initial case severity.

Results: Of 872 cases, 82 reported unsuppressed viral loads. Of these, 78% were African American and 13% were White. Of MSM, 10% were unsuppressed, and among heterosexual contact 11% were unsuppressed. Mode of transmission, race, and age group at diagnosis were not significant factors contributing to viral suppression. Distance from public transportation was significantly related to a downward trend in viral load among unsuppressed (p = 0.035) while frequency of visits were not, when controlled for race, mode of transmission, and age group.

Conclusion: Access to care plays a significant role in achieving viral suppression. This study points to the importance of structural changes to provide better continuity between public transportation and HIV care providers.