Transit Accessibility and Engagement in HIV Care in Baltimore, Maryland

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.