A Mixed Methods Study of Perceptions of a Rideshare Intervention to Address Transportation Vulnerability among People...

IntroductionTransportation vulnerability is a major barrier to HIV care for many people living with HIV (PLHIV)-especially in the rural southern United States (US), given limited public transportation infrastructure and long travel times to HIV care. Rideshare services have proliferated in recent years, and rideshare interventions are now being used in some HIV clinics to overcome transportation barriers. However, little is known about how PLHIV in the southern US perceive rideshare services and whether they are willing to use them to access HIV care-information that is critical for optimizing the implementation of rideshare interventions. The goal of this mixed-methods study was to examine implementation-related factors relevant to uptake of a concierge rideshare intervention among PLHIV in South Carolina.MethodsA total of 160 PLHIV with self-reported transportation vulnerability were enrolled in a randomized clinical trial to test effectiveness of a concierge rideshare intervention. Prior to intervention implementation, all PLHIV completed brief surveys assessing transportation-related barriers to HIV care and implementation-related factors pertaining to rideshare services. Additional semi-structured individual interviews were also completed by a smaller subset of participants (n = 20) to capture personal experiences and insight into perceptions of rideshare services for accessing HIV care.ResultsMean scores indicated favorable perceptions of rideshare interventions across the domains of comfort, ease of use, and safety. However, mean scores also indicated participant concerns with costs associated with rideshare, as well as privacy protections. T-tests showed nonsignificant differences in perceptions of rideshare by gender. Qualitative analysis yielded six key themes-"safety/comfort," "privacy protections", "appeal/enjoyment," "convenience/ease", "issues encountered", and "cost"-which aligned with three implementation factors (ie, feasibility, acceptability, adoption) that are relevant for successful implementation of rideshare interventions.ConclusionWhile the majority of PLHIV had favorable views of using rideshare services to access HIV treatment and care, several obstacles need to be addressed to ensure the success of rideshare interventions, including HIV-related stigma and technological barriers.