A Geospatial Analysis of the Relationship between Virologic Outcomes of HIV-Infected Patients on Antiretroviral Therapy and Clinic Distance and Travel Time
The Rakai Health Sciences Program (RHSP) in Rakai, Uganda has been instrumental in the fight against HIV/AIDS in Uganda over the past 25 years.(1, 2) A further area of inquiry that remains relatively unexplored in Rakai is that of geospatial analysis of HIV care and treatment outcomes. Geographic Information Systems (GIS) analytics has enormous potential to impact the field of public health; however, it remains underutilized, especially within global health and HIV/AIDS.(3, 4) Vast amounts of geospatial data have been collected by RHSP, however it has not been integrated into a coherent, standardized database, nor have any analyses been performed on patient-level HIV treatment outcomes. The first aim of this project is to integrate RHSP data into a comprehensive geospatial database as it relates to HIV/AIDS care. Multiple, disparate sources of data will be interwoven to produce an integrated dataset. With this database, it will then be possible to address questions relating to HIV care and the targeting of resources. Spatial analysis in GIS promises a unique perspective and better understanding of barriers and facilitators to care by layering population, disease prevalence, facility location, and road network data. Euclidean distance versus estimated travel times to clinics by various modes of transportation on various road conditions/routes will be estimated. This database will then be further utilized to accomplish a second aim: to perform analyses exploring the relationship between the location of clinics, travel times, and virologic outcomes of HIV-infected patients on antiretroviral therapy (ART). This is a critical implementation science question to help inform the scale-up of ART in this and similar settings. It will help to ascertain whether services are matching with the needs of the target population as well as help produce a better understanding of potential barriers to HIV care in this low-resource setting.