Embed Size (px)
DESCRIPTION
This poster describes the use of GIS mapping and HIV surveillance data to identify access to care factors among the Hispanic population. Data was collected by the Houston Department of Health and Human Services and presented at the 17th Texas HIV/STD Conference in Austin, TX on May 26th, 2010.
Citation preview
The population of Harris County, Texas is estimated 3.9 million residents of whom 1.5 million (38%) identify as Hispanic origin.
Previous research shows that Hispanic people living with HIV/AIDS (PLWHA) in Houston, Texas are 1.86 times more likely to have been diagnosed as late testers compared to the non-Hispanic, white PLWHAs.
From an earlier study it was found that 86% of the Hispanic population in high morbidity areas use their personal vehicle as transportation to a healthcare setting.
Figure 1 shows 5% of the study population lived within 1 mile of the facility of diagnosis. There were 51% who drove between 1-9 miles with the remaining 44% traveling more than 10 miles to the facility.
Figure 2 shows close to 40% of the study population did not have a publicly-funded HIV testing facility within 3 miles while 47% of the population had 1-4 of these facilities available. There were 5 or more facilities available for 13% of the group.
Figure 3 illustrates more than half of the study population had either zero or 1 publicly funded HIV testing facility within 3 miles.
Figure 4 describes the relationship between accessibility (miles traveled) and availability of care (number of facilities).
Table 1 includes logistic regression analysis which shows that Hispanics, Males, Risk Factors and Age at HIV diagnosis are significantly associated with a late HIV diagnosis.
Figure 5 illustrates the density clusters of patients in relation to the 37 public-funded HIV testing sites in Houston.
Results (cont’d) Background
Describe accessibility to care as distance traveled from residence to facility of HIV diagnosis
Describe availability to care as the number of publicly-funded HIV facilities within a search radius
Determine factors relating to access to care and significantly associated with late diagnosis of HIV*
Objectives
Identified adult HIV/AIDS cases (≥13 yrs) diagnosed in 2008 Exclusion criteria and addresses unable to be geocoded resulted in the study sample size (n=983).
The STD*MIS and eHARS databases were used for patient and provider street level addresses and demographic data.
ArcGIS Desktop 9.3 with the Network Analyst extension was used to calculate road distance between residence and facility of HIV diagnosis (accessibility to care) and to observe how many of 37 publicly funded HIV care facilities were within a 3 mile radius from the patient residence (availability of care).
Regression analysis using SAS 9.1 was used to explain the variance between residence and access to care factors.
Methods
Discussion
Using GIS Mapping and Surveillance Data to Describe Late HIV Diagnosis among the Hispanic population in Houston/Harris County, TX - 2008
Naqi Mohammad • Marissa Gonzalez • Biru Yang • Lei Zhou • Shirley Chan Houston Department of Health and Human Services • Houston, TX
Limitations
*Late diagnosis of HIV is defined as an AIDS diagnosis within 1 year of the HIV diagnosis.
Those without a publicly-funded site within 3 miles had to travel further distances to the facility of HIV diagnosis.
Patients within walking distance of the facility of diagnosis are about half as likely to be diagnosed as late as compared to those traveling more than 9 miles. This difference, however, was not found to be significant.
Although 40% of the population did not have a publicly-funded site within the search radius, our study found no significant association between this fact and a late diagnosis of HIV/AIDS.
Future studies may include a larger sample size across more years in association with unmet healthcare needs and socioeconomic factors.
Presented at the 17th Texas HIV/STD Conference • May 24-27, 2010 • Austin, TX
Some patient and provider addresses (118 out of 1101, 10.7%) were unable to be geocoded in ArcMap due to:
♦ homeless or PO Box address listed for patient, address of a jail setting or homeless shelter given as facility of HIV diagnosis, HDHHS Mobile Unit testing locations listed, or Network Analyst extension in ArcMap was not able to identify a usable route
Some HIV cases may have progressed to AIDS by the end of 2009 and may not have been identified in this dataset as late HIV diagnoses.
Special thanks to the HIV/STD Surveillance Program in the Bureau of Epidemiology and staff in the Bureau of Community Health Statistics, Houston Department of Health and Human Services. This project was supported by cooperative agreements from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the CDC.
Acknowledgements
Conclusions
Risk Factors Adjusted ORs
Male 1.93 1.30 2.88
Hispanic 1.97 1.44 2.69
IDU 2.71 1.24 5.90MSM-IDU 2.44 0.44 13.64Heterosexual 2.22 1.44 3.43No Identified Risk 1.88 1.30 2.71
13-19 0.50 0.19 1.3230-39 1.66 1.14 2.4240-49 1.88 1.26 2.8150+ 2.79 1.75 4.43
Within Walking Distance (< 1 mile) 1.25 0.93 1.68Shorter Distance (1-9 miles) 0.57 0.26 1.27
1 to 4 0.96 0.71 1.305 or more 0.85 0.53 1.36
Table 1: Demographic and Access to Care Factors Associated with Late HIV Diagnosis in Houston, Harris County TX 2008
Age at HIV Diagnosis (Ref=20-29 years old)
95% Confidence IntervalsSex(Ref=Female)
Mode (Ref=MSM)
Race/Ethnicity (Ref=Non-Hispanic)
Distance Traveled (Ref=9+ miles)
Number of Facilities Within 3 miles (Ref=None)
Figure 3: Publicly-Funded HIV Testing Sites Within Three Miles
0
50
100
150
200
250
300
350
400
450
None 1 2 3 4 5 6 7 8 9 10 11 12
Number of Publicly-Funded HIV Testing Sites Within Search Radius
Patie
nts
Affe
cted
Figure 1: Distance Traveled to Facility of HIV Diagnosis
Longer distance
(10+ miles)44%
Shorter distance
(1-9 miles)51%
Walking distance (>1 mile)
5%
Figure 2: Number of Publicly-Funded HIV Testing Sites Within Three Miles
None40%
1-4 Facilities47%
5+ Facilities 13%
Figure 4: Distance Traveled in Relation to Number of Publicly-Funded HIV Testing Sites Within Three Miles
0
2
4
6
8
10
12
14
0 10 20 30 40 50 60
Distance Traveled to Facility of HIV Diagnosis
Num
ber
of P
ublic
ly-F
unde
d H
IV
Site
s W
ithin
Thr
ee M
iles
Average travel distance=8.19 (std.dev=7.83)
Average travel distance=9.09 (std.dev=7.03)
Average travel distance=10.61 (std.dev=7.82)
Results
Contact Info: [email protected]
