Transit Accessibility and Engagement in HIV Care in Baltimore, Maryland

Bibliographic Data

ID24229379
AuthorsLauren C Zalla (0000-0001-7665-2230), Joyce L Jones, Richard D Moore (0000-0001-8250-5069), Nicholas Schweizer, Jeanne C Keruly, LaQuita N Snow (0000-0001-8395-0746), Rahel Dawit (0000-0002-3599-3597), Lorraine T Dean (0000-0002-2272-2755), Anthony T Fojo (0000-0002-9101-7910), Catherine R Lesko (0000-0002-1717-2592)
Year2026
Publication date2026-10-16
Open AccessYes
TypeARTICLE
VenueJournal of Urban Health (JOURNAL)
Journal identifiersISSN: 1099-3460 • E-ISSN: 1468-2869
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1007/s11524-026-01138-3
LanguageEN
References cited27

Transit systems may play an important role in ensuring equitable access to care among people with HIV. We estimated the association between transit time-to-clinic and the probability of missing a scheduled clinic visit among persons receiving comprehensive HIV care in Baltimore, Maryland. We estimated transit time-to-clinic using patient residential addresses geocoded to the census block group level, street maps, transit routes, and timetables. We estimated differences in the probability of missing a scheduled clinic visit across transit time categories. One thousand two hundred thirty-three participants scheduled a median of 4 clinic visits each (interquartile range [IQR]: 2, 6) in 2024. Estimated median transit time-to-clinic was nearly 4 times as long as median driving time, at 39 min (IQR: 27, 51) vs. 11 min (IQR: 6, 16). Shorter transit time-to-clinic was associated with a higher probability of missing a scheduled visit; for example, individuals living in areas from which the clinic was not transit-accessible were 8% less likely to miss a visit than those living 1–30 min away (95% confidence interval [CI] –13%, –3%). After adjusting for covariates including sex, age, race/ethnicity, insurance type, income, and area-level socioeconomic deprivation, this difference was attenuated (−3%; 95% CI −9%, 4%). In summary, among individuals receiving comprehensive HIV care in Baltimore, shorter transit time-to-clinic was associated with a higher probability of missing a clinic visit. The clinic’s location, in a transit-accessible but socioeconomically disadvantaged area, its flexible scheduling practices, and provision of transportation support services likely account for the inverse association between transit accessibility and visit attendance in this context.

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