People in rural Africa living with HIV dwell far from care centres

Sunday December 05 2021
Pre-Exposure Prophylaxis

Pre-Exposure Prophylaxis for HIV. Many people living with HIV in Africa do not have access to regular treatment. FILE PHOTO | COURTESY


Many people living with HIV in rural Africa are not receiving regular treatment due to the long distances they have to travel to get their medication.

New research has revealed that despite efforts to increase the number of those diagnosed with HIV who receive antiretroviral therapy, 28 percent of people living with HIV (PLHIV) aged 15 years and older in eastern and southern Africa, and 42 percent in western and central Africa were not receiving the treatment in 2019.

The study, When Distance Matters: Mapping HIV health care underserved communities in sub-Saharan Africa, was published in the journal PLOS Global Public Health on November 2.

Researchers created maps of underserved areas where people cannot access the closest health care facilities within appropriate travel time in sub-Saharan Africa.

The maps identified populations living within a 10, 30 and 60-minute walk or drive. They found that 1.5 million people living with HIV lived more than an hour’s drive from the nearest health facility.

Disparities in care


The study identified disparities in the availability of care across countries. People living in more than 90 percent of Sudan and Mauritania had to drive more than an hour for health services.

In 17 countries, about half of the population with HIV live in places with limited access to health care, the study found.

In Kenya, Rwanda and Burundi, almost nobody has to drive more than an hour to the nearest clinic, doctor’s office or hospital for treatment.

In Kenya, Rwanda, Uganda and Burundi have less than 20 percent of PLHIV in under-served areas with 60-minute travel time, but Eritrea and South Sudan show more than 70 percent of PLHIV with an hour’s travel time.

Larger countries like South Sudan, Mauritania, and the Democratic Republic of the Congo were found to have larger underserved areas from health care facilities compared with smaller nations such as Cape Verde, Rwanda, and Burundi.

However, Nigeria, South Africa, and Kenya had smaller underserved areas than those in smaller countries.

Researchers with the University of Cincinnati identified the challenge faced by PLHIV in accessing health services.

The researchers say they identified more than seven million PLHIV with access to health care with a 10-minute travel time.

“Our study has noted the role of underserved areas as a potential source of HIV transmission,” they said in their findings. “These long distances make or break strategies to reduce the incidence of HIV.”

Furthermore, Covid-19 lockdowns and other restrictions disrupted HIV testing, and in many countries also led to steep drops in diagnoses and referrals for treatment. The Global Fund to Fight AIDS, Tuberculosis and Malaria reported that in 32 African and Asian countries, HIV testing declined by 41 percent and referrals for diagnosis and treatment dropped by 37 percent in 2020, compared with the same period in 2019.

“Identifying areas where health care services cannot be accessed within appropriate travel time and identifying vulnerable populations at high risk of infection need to be prioritized to meet global targets for 2025,” said co-author and assistant professor and director of UC’s Health Geography and Disease Modeling Lab, Diego Cuadros. “Access to the nearest health care facility is one of the most important measures for HIV treatment success.”

To cover geographically marginalised populations with clinical care, the researchers suggest innovative targeting of health care services is required, including decentralisation of HIV care, and mobile health care which has been used to fill the void in some areas.

Another consideration is the transportation infrastructure in rural Africa. Kim said public transportation is not readily available in some rural areas while storm-damaged roads and bridges can temporarily limit access.

The study is an international collaboration between UC and scientists in Zimbabwe and Dubai as well as Oregon State University.