Mapping Women’s Access to Reproductive Health and HIV Services in Zambia
Name: Tahvi Frank
School: Vagelos College of Physicians and Surgeons, Class of 2023
Mentor: Andrea Low, MD PhD
Abstract
Multinational organizations have called for integration of reproductive health services with HIV care in order to enhance the reproductive rights of women living with HIV, increase accessibility of modern contraception, and improve HIV outcomes. This study aimed to investigate geographic accessibility of HIV and reproductive care services in Zambia using data from ZAMPHIA (Zambia Population-Based HIV Impact Assessment) 2016, a nationally representative cross-sectional household survey. From this data set, we identified 13,024 women ages 15-49 and utilized geomasked enumeration area centroids as an approximation for household location. Travel time to nearest health facility was estimated using the AccessMod software. AccessMod calculates travel time using a “cost” surface, taking into account land cover, elevation, and modes of transit. Health facility geolocation data was provided by the Centers for Disease Control and Prevention. Logistic regression was used to model the relationship between travel time and HIV and reproductive health outcomes. Women living at a distance greater than 1 hour from a health facility were less likely to have received an HIV test in the last 12 months (OR = 0.688), and those who were HIV positive were less likely to be aware of their HIV status (OR = 0.502). Women living over 1 hour from a health facility were also less likely to be using modern contraception (OR = 0.771) and were more likely to have an unmet need for contraception (OR = 1.20). This study underscored the need for increased access to healthcare for remote, underserved populations.