In sub-Saharan Africa, 7 million people with HIV live more than 10 minutes from health care services and 1.5 million people with HIV live more than 60 minutes from a healthcare facility, according to a new study published this week in the open-access journal PLOS Global Public Health by Diego Cuadros of the University of Cincinnati, and colleagues.
HIV/AIDS has been a leading cause of morbidity and mortality for several decades in parts of Africa. Despite efforts to increase the proportion of individuals diagnosed with HIV who receive anti-retroviral therapy (ART), between a quarter and a half of all people with HIV in Africa, depending on the region, were not receiving ART in 2019. To improve these numbers and meet global targets for HIV treatment rates, removal of geographic barriers and improvement of access to health services are vital.
In the new study, researchers analyzed data on the number of people living with HIV in 47 African countries, the population distribution within these countries, and the locations of healthcare facilities. By combining this data they were able to map out, for every 5-kilometer square, how far HIV patients live from access to care, using either motorized transportation or walking only.
The map revealed that 90.5% of the total land area analyzed was more than 10 minutes from the nearest healthcare facility, with 7 million people with HIV (35% of HIV patients) living in this area. 74.6% of the land area was more than 30 minutes from healthcare (containing 3 million people with HIV, 15.6% of patients), and 58.9% of the land area was greater than 60 minutes away (containing 1.5 million people with HIV, 7.6%). The numbers varied by country, with only 1.6% of areas in Swaziland located 60 minutes from healthcare, for instance, but more than 90% of areas within Sudan and Mauritania. Results were also different when walking time, rather than motorized transport time, was considered; 33.0% of people living with HIV (or 6.6 million people) lived more than a 60 minute walk from the nearest healthcare facility.
The authors conclude that the findings and new map can contribute to developing cost-effective policies for HIV interventions aimed at underserved areas. For areas where people are far from healthcare facilities, alternatives could be suggested to improve accessibility, such as differentiated service delivery or mobile outreach for HIV services.
The authors add: "Unequal access to healthcare facilities and structural inequality are just some of the systemic hurdles many communities face. This issue is deeper in regions suffering a generalized HIV epidemic like Africa, where more than 1.5 million people living with HIV are located in underserved rural communities"
Kim, H., et al. (2021) When distance matters: Mapping HIV health care underserved communities in sub-Saharan Africa. PLoS Global Public Health. doi.org/10.1371/journal.pgph.0000013.