Geospatial disparities in access to clinical trials for AIDS-defining malignancies in the continental United States.

Abstract

e13735 Background: Persons living with HIV (PWH) have historically faced significant disparities accessing healthcare. While AIDS-related mortality continues to fall, AIDS-defining malignancies remain an important cause of morbidity and mortality for PWH. Disparities in travel time have been shown to impact health outcomes for PWH, but few studies have examined access to cancer care for PWH in the United States. Methods: Clinicaltrials.gov was queried to identify trials in the United States for four representative AIDS-defining malignancies: Kaposi sarcoma (KS), diffuse large B-cell lymphoma (DLBCL), primary CNS lymphoma (PCNSL), and Burkitt lymphoma (BL). Interventional clinical trials with start dates from January 1, 2000 to September 1, 2024 for adult patients (≥age 18) were eligible for review. All studies were reviewed individually for relevance. Trials were divided based on HIV status eligibility criteria: PWH only (HIV+), persons without HIV only (HIV-), and persons with or without HIV (HIV+/-). Geographic coordinates of all trial sites were extracted, and a transportation network was created in R to determine travel time from each zip code to nearest trial site. Access was measured in five-year intervals and compared between PWH (HIV+ or HIV+/-) and persons without HIV (HIV- or HIV+/-). Census data were used to calculate population-weighted median travel times and percent population with three-hour access. Results: 3173 trials were reviewed. 1344 met inclusion criteria (54 KS, 841 DLBCL, 120 PCNSL, and 329 BL). Of trials for KS, 21 (38.8%) were for HIV+, 4 (7.4%) for HIV-, and 29 (53.7%) for HIV+/-. For DLBCL, 14 (1.7%) were for HIV+, 502 (59.7%) for HIV-, and 325 (38.6%) for HIV+/-. For PCNSL, 3 (2.5%) were for HIV+, 72 (60.0%) for HIV-, and 45 (37.5%) for HIV+/-. For BL, 9 (2.7%) were for HIV+, 185 (56.2%) for HIV-, and 135 (41.0%) for HIV+/-. Median population-weighted travel time in hours, interquartile range (IQR), and three-hour access are shown in Table 1. Conclusions: While geospatial access to clinical trials for AIDS-defining malignancies has generally improved over the last 25 years, access for PWH to clinical trials still lags behind access for persons without HIV for PCNSL and BL despite higher incidence of these cancers in PWH. Further efforts are needed to expand access to trials for AIDS-defining malignancies for PWH. 2000-04 PWH 2000-04 Without HIV 2020-24 PWH 2020-24 Without HIV KS Travel Time (IQR) 3.68 (1.44-7.87) 8.61 (3.01-16.50) 2.68 (0.85-5.91) 2.84 (0.81-6.02) % 3-Hour Access 42.4 25.0 52.6 51.2 DLBCL Travel Time (IQR) 0.94 (0.43-2.13) 0.59 (0.29-1.28) 0.48 (0.25-1.03) 0.47 (0.24-1.02) % 3-Hour Access 84.9 95.8 97.2 97.3 PCNSL Travel Time (IQR) 2.55 (0.95-5.10) 1.26 (0.50-2.97) 1.02 (0.44-2.45) 0.79 (0.37-1.86) % 3-Hour Access 54.9 75.3 80.6 87.0 BL Travel Time (IQR) 0.98 (0.44-2.19) 0.63 (0.31-1.41) 1.72 (0.66-3.49) 1.38 (0.56-3.16) % 3-Hour Access 84.2 94.3 69.0 73.5