The spatiotemporal distribution of pre-exposure prophylaxis accessibility in the United States, 2016-2020
The spatiotemporal distribution of pre-exposure prophylaxis accessibility in the United States, 2016-2020
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DOI：
10.1016/j.annepidem.2021.09.006
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发表时间：
2021-10-21
影响因子：
5.6
通讯作者：
Sullivan, Patrick S.
中科院分区：
文献类型：
--
作者：
Sharpe, J. Danielle;Guest, Jodie L.;Sullivan, Patrick S.
目的：居住在对艾滋病毒暴露前预防(PrEP)提供者或PrEP沙漠几乎没有空间可及性的地区，导致PrEP摄取率较低。这项研究考察并描述了美国PrEP可及性随时间的空间分布。方法：我们通过空间网络分析和地理制图来探索持久PrEP沙漠(2016和2020年可达性不佳的普查区域)、新的PrEP沙漠(2020年可及性不佳的区域)、新的PrEP绿洲(2016年可及性不佳的区域)和持久的PrEP绿洲(2016和2020年可及性最佳的区域)的时空分布。我们使用多分类Logistic回归来确定与这四种时空PrEP可及性类型相关的区域水平因素。结果：从2016年(28,055片)到2020年(13,240片)，30分钟的PrEP沙漠的流行率下降了52.8%，从2016年(44,259片)到2020年(59,074片)，30分钟的PrEP绿洲增加了33.5%。在所有区域中，12487个(17.3%)为持久的PrEP荒漠，753个(1.0%)为新的PrEP荒漠，15568个(21.5%)为新的PrEP绿洲，43506个(60.1%)为持久的PrEP绿洲。总体而言，持久的PrEP绿洲与其他时空PrEP可达性类型相比，更有可能具有更高的社会经济地位，种族/民族多样性，位于城市地区和东北部，并因城市化和美国人口普查区域而异。结论：S改善PrEP可及性的努力应特别侧重于非城市地区以及南部、中西部和西部的贫困社区。监测PrEP空间可及性随时间的变化并确定与这种变化相关的因素，有助于评估在改善PrEP可及性方面取得的进展。(C)2021 Elsevier Inc.保留所有权利。
Purpose: Residing in areas with little spatial accessibility to HIV pre-exposure prophylaxis (PrEP) providers, or PrEP deserts, contributes to low PrEP uptake. This study examines and characterizes the spatial distribution of PrEP accessibility in the United States over time. Methods: We conducted spatial network analyses and geographic mapping to explore the spatiotemporal distribution of persistent PrEP deserts (census tracts with suboptimal accessibility in 2016 and 2020), new PrEP deserts (tracts with suboptimal accessibility in 2020 but not 2016), new PrEP oases (tracts with suboptimal accessibility in 2016 but not 2020), and persistent PrEP oases (tracts with optimal accessibility in 2016 and 2020). We used polytomous logistic regression to determine area-level factors associated with these four spatiotemporal PrEP accessibility types. Results: There was a reduction of 52.8% in the prevalence of 30-minute PrEP deserts from 2016 (28,055 tracts) to 2020 (13,240 tracts) and an increase of 33.5% in 30-minute PrEP oases from 2016 (44,259 tracts) to 2020 (59,074 tracts). Of all tracts, 12,487 (17.3%) were persistent PrEP deserts, 753 (1.0%) were new PrEP deserts, 15,568 (21.5%) were new PrEP oases, and 43,506 (60.1%) were persistent PrEP oases. Overall, persistent PrEP oases were more likely to be of higher socioeconomic status, racially/ethnically diverse, located in urban areas, and located in the Northeast compared with other spatiotemporal PrEP accessibility types, with variation by urbanicity and U.S. Census region. Conclusions: Effort s to improve PrEP accessibility should be especially focused in disadvantaged communities in nonurban areas and the South, Midwest, and West. Monitoring changes in the spatial accessibility of PrEP over time and determining the factors associated with such changes can help to evaluate progress made towards improving PrEP accessibility. (c) 2021 Elsevier Inc. All rights reserved.