Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United States
Geographic Access to Preexposure Prophylaxis Clinics Among Men Who Have Sex With Men in the United States
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DOI：
10.2105/ajph.2019.305172
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发表时间：
2019-09-01
影响因子：
12.7
通讯作者：
Weiss, Kevin M.
中科院分区：
文献类型：
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作者：
Siegler, Aaron J.;Bratcher, Anna;Weiss, Kevin M.
目标。探索艾滋病毒暴露前预防 (PrEP) 提供者有限的美国地理区域，PrEP 沙漠。方法。我们从 2017 年以来的国家 PrEP 提供者数据库中获取了公开列出的 PrEP 提供者，并从公共数据中获得了县级城市分类和男男性行为者 (MSM) 的人口估计。我们计算了从人口普查区到最近的提供商的旅行时间。如果单程驾驶时间超过 30 或 60 分钟，我们将人口普查区归类为 PrEP 沙漠。结果。八分之一符合 PrEP 资格的 MSM（108 758/844 574；13%）生活在 30 分钟车程的沙漠中，相当一部分人生活在 60 分钟车程的沙漠中（38 804/844 574；5%）。南部地区和较低的城市化程度与 PrEP 沙漠状态的几率增加密切相关。结论。大量艾滋病毒传播高危人群居住在附近没有 PrEP 提供者的地方。农村和南部地区受到的影响尤为严重。公共卫生影响。为了最大程度地提高 PrEP 的实施效果，地理位置不应决定获取途径。需要培训临床医生、扩大 PrEP 护理场所和提供远程医疗服务的计划。
Objectives. To explore US geographic areas with limited access to HIV preexposure prophylaxis (PrEP) providers, PrEP deserts.Methods. We sourced publicly listed PrEP providers from a national database of PrEP providers from 2017 and obtained county-level urbanicity classification and population estimates of men who have sex with men (MSM) from public data. We calculated travel time from census tract to the nearest provider. We classified a census tract as a PrEP desert if 1-way driving time was greater than 30 or 60 minutes.Results. One in 8 PrEP-eligible MSM (108 758/844 574; 13%) lived in 30-minute-drive deserts, and a sizable minority lived in 60-minute-drive deserts (38 804/844 574; 5%). Location in the South and lower urbanicity were strongly associated with increased odds of PrEP desert status.Conclusions. A substantial number of persons at high risk for HIV transmission live in locations with no nearby PrEP provider. Rural and Southern areas are disproportionately affected.Public Health Implications. For maximum implementation effectiveness of PrEP, geography should not determine access. Programs to train clinicians, expand venues for PrEP care, and provide telemedicine services are needed.