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BACKGROUND: Persons infected with Human immunodeficiency virus (HIV) can gain years of life if antiretroviral treatment is initiated early in the course of the disease. The Centers for Disease Control (CDC) recommends that persons at risk for HIV infection should be screened for the disease at least annually. Many organizations throughout the United States provide services related to HIV, including testing. The purpose of this study was to determine the proportions of the general and the HIV diagnosed populations that are located between 0-15 minutes, 16-30 minutes, 31-45 minutes, or greater than 45 minutes drive-time to the closest fixed HIV test site, and to identify areas with high HIV disease burden over the past 5 years in the state of Virginia.
METHODS: Fixed HIV test sites in and around the state were identified, and geographic information systems (GIS) software was used to create drive time networks around each site. Surveillance data on new HIV diagnoses between 2009 and 2013 were geocoded and compared with the site networks. Geographically significant HIV burden areas were determined using the Getis-Ord Gi* Spatial Statistics tool.
RESULTS: There were 290 fixed HIV test sites, and 67% of them had free HIV testing available. There were 4,691 new HIV diagnoses between 2009 and 2013. Nearly 56% of Virginia’s population lived between 0-15 minutes drive-time to the closest HIV test site; 30% were between 16-30 minutes; 8% were between 31-45 minutes; and only 7% were over 45 minutes. About 90% of new HIV diagnoses were located within 15 minutes of the nearest organization that provided any type of HIV testing, and 85% were located within 15 minutes of at least one site where free testing was available. Statistically significant hot spots for new HIV diagnoses were found in the Northern, Central and Eastern health regions of the state, with Z scores between 1.96-7.30 and P < 0.05.
CONCLUSIONS: Almost all high burden areas for HIV cases newly diagnosed between 2009 and 2013 were located between 0-15 minutes drive-time of the nearest organization that provides HIV testing. However, the few remaining high burden HIV areas, and the remaining 44% of the general population beyond 15 minutes drive-time, should be assessed for alternatives, such as mobile HIV test site distributions or transportation assistance.