Assessing the relationship between physician availability and viral load suppression in British Columbia. (24th December 2017)

• Record Type: Journal Article
• Authors: Amram, Ofer; Wang, Lu; Sereda, Paul; Shoveller, Jean A.; Barrios, Rolando; Montaner, Julio S.G.; Lima, Viviane D.
• Is Part Of: Canadian geographer. Volume 62:Number 2(2018)
• Page Start: 120
• Page End: 129
• Publication Date: 2017-12-24
• Subjects: physician availability -- antiretroviral therapy -- viral load suppression -- GIS; disponibilité de médecins -- thérapie antirétrovirale -- élimination de la charge virale -- SIG; Geography -- Periodicals; 910
• DOI: 10.1111/cag.12433
• Languages: English
• ISSNs: 0008-3658

Abstract

Abstract : In 2014, the Joint United Nations Programme on HIV/AIDS set the target of dramatically reducing the burden of HIV through expansion of access to timely HIV treatment. In order to achieve this target, it is necessary to expand access to care along the HIV cascade of care. This study examines the relationship between viral suppression and the availability of physicians providing HIV treatment in British Columbia, Canada. Data from the Drug Treatment Program of the British Columbia Centre for Excellence in HIV/AIDS was analyzed. The floating catchment method was used to assess physician availability and multivariable logistic regression was used to implement a confounder selection technique to independently assess the relationship between physician availability and viral load suppression. Individuals with more than 25 physicians within a one‐hour catchment were more likely to reside in urban areas and almost twice as likely to have a suppressed viral load (adjusted odds ratio: 1.97; 95% CI 1.50 – 2.58). This study highlights the impact of physicians' availability on viral load levels. Mapping technology was used to identify the locations in which patients were most impacted by the lack of physicians. Key Messages: Individuals residing in areas where there are substantially fewer physicians available to provide HIV treatment have a higher chance of not achieving viral suppression. Individuals residing in rural areas have poorer health outcomes when compared to those residing in urban areas. Discrepancies in HIV treatment outcomes exist despite the fact that HIV treatment costs are borne directly by government.