Measuring spatial accessibility to healthcare for people living with HIV-AIDS in southern Nigeria

Sammanfattning: Equitable distribution of healthcare services towards the reduction of HIV-AIDS prevalence in Nigeria remains a major public health concern. One of several research model to solve this public health problem is the use Geographical Information System, a two-step floating catchment area (2SFCA), this model emerged in the last decade as a key measure of spatial accessibility, particularly in its application to healthcare access. The 2SFCA approach was used to study the influence of distance to health center on people living with HIV-AIDS. Individual, health and administrative data from the South-South region of Nigeria were used in this study for two scenarios, at 30 and 60 minutes travel time. At a threshold travel time of 30 minutes, the 2SFCA results showed minimum accessibility index score of 0.45 HIV-AIDS services with access to services by 16% of HIV infected population. At 60 minutes threshold, there was a minimum of 0.24 HIV services accessible index score, only 12% had access to HIV-AIDS services. Spatial autocorrelations for Global Moran’s I showed a significant clustered pattern at 30 minutes threshold. Anselin Local Moran’s I revealed the extent of hotspots pattern identifying eleven LGAs to be of high-high cluster. Furthermore, analysis of variance test statistic also compared the effect of accessibility index score and the household knowledge on distance or travel time as a barrier to HIV services, the test statistic at (p<0.05) showed significant differences between the States. These results are key decision-making factor for local authorities to establish equitable access to HIV-AIDS population in the South-South region. Conclusively, this showed a shortage of HIV services in all the States, distance and means of transport remains a significant hindrance to healthcare access, these can be addressed with the incorporation of Geographical Information System in future monitoring strategy.