{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T11:43:12Z","timestamp":1792410192187,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2019,4,29]],"date-time":"2019-04-29T00:00:00Z","timestamp":1556496000000},"content-version":"vor","delay-in-days":28,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100005564","name":"Gilead Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100005564","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K23 MH114760"],"award-info":[{"award-number":["K23 MH114760"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Intern AIDS Soc"],"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Geographic and transportation barriers are associated with poorer <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010related health outcomes in sub\u2010Saharan Africa, but data on the impact of these barriers on prevention interventions are limited. We estimated the association between distance to clinic and other transportation\u2010related barriers on pre\u2010exposure prophylaxis (Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>) uptake and initial clinic visit attendance in a rural community in southwestern Uganda enrolled in the ongoing <jats:styled-content style=\"fixed-case\">SEARCH<\/jats:styled-content> study (<jats:styled-content style=\"fixed-case\">NCT<\/jats:styled-content>01864603).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Community\u2010wide <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content> testing was conducted and offered to adult (\u226515\u00a0years) participants in Ruhoko. Participants were eligible for Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> based on an empiric risk score, having an <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u2010discordant partner, or self\u2010referral at either the community health campaign or during home\u2010based testing from March to April 2017. We collected data from Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>\u2010eligible households on <jats:styled-content style=\"fixed-case\">GPS<\/jats:styled-content>\u2010measured distance to clinic, walking time to clinic and road difficulty. A sample of participants was also asked to identify their primary barriers to Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> use with a semi\u2010quantitative questionnaire. We used multivariable logistic regression to evaluate the association between transportation barriers and (1) Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> uptake among Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>\u2010eligible individuals and (2) four\u2010week clinic visit attendance among Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> initiators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 701 Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content>\u2010eligible participants, 272 (39%) started Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> within four weeks; of these, 45 (17%) were retained at four weeks. Participants with a distance to clinic of \u22652\u00a0km were less likely to start Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 0.34; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.15 to 0.79, <jats:italic>p<\/jats:italic>\u00a0=\u00a00.012) and less likely to be retained on Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> once initiated (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 0.29; 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.10 to 0.84; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.024). Participants who were deemed eligible during home\u2010based testing and did not have the option of same\u2010day Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> start were also substantially less likely to initiate Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">aOR<\/jats:styled-content> 0.16, 95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.07 to 0.37, <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Of participants asked to name barriers to Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> use (N\u00a0=\u00a098), the most frequently cited were \u201cneeding to take Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> every day\u201d (N\u00a0=\u00a018) and \u201clow\/no risk of getting <jats:styled-content style=\"fixed-case\">HIV<\/jats:styled-content>\u201d (N\u00a0=\u00a018). Transportation\u2010related barriers, including \u201cclinic is too far away\u201d (N\u00a0=\u00a06) and \u201ctravel away from home\u201d (N\u00a0=\u00a04) were also reported.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Distance to clinic is a significant predictor of Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> uptake and four\u2010week follow\u2010up visit attendance in a community in rural Uganda. Interventions that address geographic and transportation barriers may improve Pr<jats:styled-content style=\"fixed-case\">EP<\/jats:styled-content> uptake and retention in sub\u2010Saharan Africa.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.25276","type":"journal-article","created":{"date-parts":[[2019,5,1]],"date-time":"2019-05-01T02:09:09Z","timestamp":1556676549000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Distance to clinic is a barrier to Pr<scp>EP<\/scp> uptake and visit attendance in a community in rural Uganda"],"prefix":"10.1002","volume":"22","author":[{"given":"Christopher M","family":"Mayer","sequence":"first","affiliation":[{"name":"Albany Medical College Albany NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asiphas","family":"Owaraganise","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Kabami","sequence":"additional","affiliation":[{"name":"Infectious Diseases Research Collaboration Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalsone","family":"Kwarisiima","sequence":"additional","affiliation":[{"name":"Makere University Joint AIDS Program Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine A","family":"Koss","sequence":"additional","affiliation":[{"name":"University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edwin D","family":"Charlebois","sequence":"additional","affiliation":[{"name":"University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moses R","family":"Kamya","sequence":"additional","affiliation":[{"name":"Makere University Kampala Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya L","family":"Petersen","sequence":"additional","affiliation":[{"name":"University of California Berkeley Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diane V","family":"Havlir","sequence":"additional","affiliation":[{"name":"University of California San Francisco San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4275-8509","authenticated-orcid":false,"given":"Britta L","family":"Jewell","sequence":"additional","affiliation":[{"name":"University of California Berkeley Berkeley CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2019,4,29]]},"reference":[{"key":"e_1_2_9_2_1","volume-title":"Guideline on when to start antiretroviral therapy and on pre\u2010exposure prophylaxis for HIV","author":"World Health Organization","year":"2015"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-014-0729-8"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1080\/09540120701244943"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-009-9533-2"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/00126334-200311010-00004"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32835fd873"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0021797"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32833fb71f"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-9-290"},{"key":"e_1_2_9_11_1","unstructured":"Uganda AIDS Commission RoU.National HIV and AIDS strategic plan 2015\/2016\u20102019\/2020. 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