Most HIV-positive patients in England live close to a specialist HIV clinic

The vast majority of HIV-positive patients in England live close to a clinic that provides specialist HIV treatment and care, a study published in the online edition of HIV Medicine shows.

Overall, 81% of patient lived within 5km of a clinic. However, only 9% of individuals used their closest service. Living in a wealthier area and having had HIV for longer were both associated with travelling greater distances to an HIV clinic.

“The provision of local HIV services in for HIV-infected adults is good in England,” comment the researchers.

In England, the majority of HIV clinical care is provided through specialist NHS HIV outpatient clinics. These provide some of the best HIV care in the world.

All the treatment and care provided by these clinics is free to people who are entitled to free NHS care. They are open access, which means that patients do not need a referral to be seen at a clinic. Moreover, individuals can choose which clinic to attend.

The British HIV Association recommends that patients who require routine, uncomplicated care should have their needs met by local services, but that patients with more complex needs should attend a more specialised unit.

However, little is known about the distance travelled by HIV-positive patients to their clinic. It is also unclear if there are social, demographic or clinical characteristics associated with travelling longer distances to access services.

To get a clearer understanding of this issue, researchers in London undertook a study including 46,550 HIV-positive adults who received HIV care in England in 2007.

They pinpointed the closest HIV clinic for each of these patients. All clinics within 5km of an individuals’ place of residence were also defined as local.

Data were also gathered on the wealth of the patients’ borough of residence, and the patients’ ethnicity, HIV risk category, length of HIV diagnosis, and HIV treatment status.

Most (66%) of the patients were men and 50% were white. The great majority (95%) lived in an urban area, and 42% resided in a locality that was economically deprived. Almost three-quarters (73%) of patients were taking antiretroviral therapy.

The median distance travelled by patients to their clinic was 2.5km; but this ranged from less than 1km to 80km.

Patients living in London travelled a short distance than those living outside the capital (2km vs. 3.7km).

Access was good: 81% of patients lived within 5km of a specialist HIV clinic, and 93% lived within 10km.

In London, patients had an average of three clinics within 5km. However, those living outside London had an average of just one clinic close to their place of residence.

The average distance travelled by patients to their clinic was a little under 5km. Overall, 73% used a local service. However, only 9% used the clinic closest to where they lived.

Individuals who were infected with HIV by blood products were the group most likely to use non-local services (51%). “These patients may need to attend specialist services that are not provided locally,” comment the authors.

Patients living in urban areas were more likely to attend a non-local clinic than those who lived in rural areas (44 vs 22%, p < 0.01).

Black African and black Caribbean patients were less likely to use a non-local service than white patients (23 vs 26% vs. 29%, p < 0.01).

Duration of diagnosis also affected the use of clinics. Individuals who had been diagnosed for at least a year were more likely to use a non-local service than those with a shorter duration of diagnosis (27 vs 20%, p < 0.01). The investigators suggest “this may be because patients may not become aware of the choices available to them until they have adjusted to their HIV diagnosis.”

Wealth also appeared to affect choice of clinic. Patients who lived in the least deprived areas were twice as likely as those living in the poorest districts to travel to non-local clinics (42 vs 21%, p < 0.01). The investigators suggest that “financial difficulty” may prevent some patients from travelling longer distances to clinics. A recent study showed that almost a third of people with HIV in the UK did not have enough money to meet their needs and that 10% had difficulty meeting travel costs.

Statistical analysis demonstrated that those living in the least deprived areas were significantly more likely to use non-local clinics than those residing in the most deprived areas (adjusted odds ratio [AOR], 2.6; 95% CI, 1.98 to 2.37).

Patients who had been diagnosed with HIV for at least a year were 50% more likely to receive care from a clinic more than 5km from their home than individuals whose HIV had been diagnosed for less than a twelve months (AOR, 1.48; 95% CI, 1.38 to 1.59).

Residing in an urban area increased the odds of using a non-local service by a quarter, and patients taking HIV treatment were also significantly more likely to use a clinic that for not local (AOR, 1.24; 95% CI, 1.17 to 1.30).

“Barriers to service choice are likely to related to poverty and unfamiliarity with the options for HIV care,” conclude the authors, “consequently, provision of local services remains vital.”

Huntingdon S et al. Travel for HIV care in England: a choice or necessity? HIV Medicine, online edition: DOI: 10.1111/j.1468-1293.2010.00891.x, 2010 (click here for the free abstract).