Spatial disparities in access to Hepatitis C treatment providers in Los Angeles County: An enhanced two-step floating...

Access to hepatitis C treatment is critical for cure, transmission prevention, and elimination efforts in the United States, yet evidence on geographic disparities in access remains limited. This study assessed spatial variation in access to hepatitis C treatment providers across zip code tabulation areas in Los Angeles County. A cross-sectional ecological study integrated provider locations, hepatitis C infection rates, and sociodemographic characteristics from the American Community Survey. Treatment providers included specialists and non-specialists identified using the National Plan and Provider Enumeration System. Spatial access ratios were calculated using the enhanced two-step floating catchment area method. Zip codes were classified as low, moderate, or high access based on the mean and standard deviation of access ratios. Multinomial regression examined associations between socioeconomic characteristics and low access. Among 255 zip codes, 13% were classified as low access, 34% as moderate access, and 53% as high access based on combined access to all providers. Overall, access was higher for non-specialists than for specialists, as 20% of zip codes were classified as having low access to specialists, compared with 17% for advanced practice providers and 15% for primary care providers. High access to specialists clustered in western areas of the county, while high access to non-specialists clustered in eastern areas. Higher poverty levels, uninsured prevalence, and a higher proportion of Hispanic residents were associated with increased odds of low access. Substantial geographic disparities in access to hepatitis C treatment providers persist across the County, highlighting opportunities to expand treatment through non-specialist care.