Evidence map›Paper›PMID 40355703›Full record

ArticleCommunications medicine2025

Analysis of travel-time to HIV treatment in sub-Saharan Africa reveals inequities in access to antiretrovirals.

Justin T Okano, Andrea Low, Luckson Dullie, Wongani Mzumara, Harriet Nuwagaba-Biribonwoha, Sally Blower

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In one paragraph

Article in Communications medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed.

  1. Article
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  3. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors.

Justin T OkanoCenter for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA.ORCID http://orcid.org/0000-0002-2476-9370
Andrea LowICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.
Luckson DulliePartners In Health/Abwenzi Pa Za Umoyo, Neno, Malawi.
Wongani MzumaraDepartment of HIV and AIDS, Ministry of Health Malawi, Lilongwe, Malawi.
Harriet Nuwagaba-BiribonwohaICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, USA.
Sally BlowerCenter for Biomedical Modeling, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA. sblower@mednet.ucla.edu.ORCID http://orcid.org/0000-0003-4342-3911

Funding

Using geospatial science to maximize the opportunity to access ART in AfricaR01AI167713 · NIAID · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI BLOWER, SALLY MARGARET · 2022 to 2024
$2.5M
NIAID NIH HHS R01 AI167713
6 · The paper itself

Abstract

backgroundUNAIDS proposes ending inequalities in access to HIV treatment. We use data from nationally-representative Population-Based HIV Impact Assessment (PHIA) surveys for Eswatini, Malawi, and Zambia to identify inequities in one-way travel-time to access antiretroviral therapy (ART) for people with HIV (PWH).

methodsUsing biometric data from the PHIAs, we construct Epidemic Surface Prevalence maps and estimate treatment coverage. Self-reported travel-time data were fit using logistic cumulative distribution functions. Multivariable logistic regression models were used to examine relationships between travel-time, urban-rural residency, age, and sex.

resultsWe find the majority of PWH on ART are women: Eswatini (69.4%), Malawi (64.8%), Zambia (63.0%). The majority on ART reside in rural areas in Malawi (74.6%) and Eswatini (71.0%), but in urban areas in Zambia (61.9%). Travel-time distribution functions show, on average, PWH in Eswatini have the shortest travel-times; travel-times in Malawi are slightly longer than in Zambia. 56.4% (Malawi), 50.5% (Zambia), and 37.4% (Eswatini) of treated individuals could not access ART within one hour; many travel more than two hours: 20.6% (Zambia), 19.0% (Malawi), 10.5% (Eswatini). In all countries, the odds of traveling one or more hours are significantly higher in rural than urban areas. In Eswatini and Zambia, women have significantly higher odds than men of traveling one or more hours.

conclusionsMany PWH spend considerable time traveling to access ART. Substantial inequities exist, disadvantaging rural populations in all three countries, and women in Eswatini and Zambia. Achieving UNAIDS' goal will require identifying drivers of inequities and designing strategies to minimize them.

Identifiers

PMID40355703
PMCPMC12069690

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.