Geospatial Access to CAR-T Clinical Trials for Non-Hodgkin Lymphoma for Persons With HIV

Area of Science:

• Oncology
• Immunotherapy
• Public Health

Background:

• Chimeric antigen receptor T-cell (CAR-T) therapy offers a transformative treatment for non-Hodgkin lymphoma (NHL).
• Non-Hodgkin lymphoma is a significant cause of cancer mortality among persons living with HIV (PWH).
• PWH are often excluded from CAR-T clinical trials, limiting their access to potentially life-saving treatments.

Purpose of the Study:

• To evaluate and compare travel accessibility to CAR-T clinical trials for NHL between the general population and PWH.
• To identify disparities in trial access based on HIV status and geographic location.

Main Methods:

• A cross-sectional study analyzed interventional CAR-T trials for NHL listed on ClinicalTrials.gov.
• Trial site locations were geocoded to calculate population-weighted median travel times for the general population and PWH.
• Trials were assessed for HIV inclusivity, and access was measured by 1-hour and 3-hour travel radii.

Main Results:

• Of 80 eligible trials, only 11 (13.8%) included PWH, while 58 (72.5%) excluded them.
• PWH faced longer median travel times (1.15 hours) compared to the general population (0.73 hours).
• Access within 1 and 3 hours was significantly lower for trials including PWH (46.1% and 82.2%) versus those excluding PWH (55.3% and 87.8%).
• Travel times were notably longer in the Southern US for trials including PWH.

Conclusions:

• Significant travel time disparities exist for PWH seeking CAR-T trials for NHL.
• Despite progress, access to CAR-T trials remains disproportionately limited for PWH, particularly in high-prevalence regions like the South.
• Enhanced strategies are necessary to improve equitable access to CAR-T therapy clinical trials for underserved populations, including PWH.