Aaron J. Siegler is with the Department of Behavioral Sciences and Health Education and Anna Bratcher and Kevin M. Weiss are with the Department of Epidemiology, Emory University, Atlanta, GA.
Am J Public Health. 2019 Sep;109(9):1216-1223. doi: 10.2105/AJPH.2019.305172. Epub 2019 Jul 18.
To explore US geographic areas with limited access to HIV preexposure prophylaxis (PrEP) providers, PrEP deserts. 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. 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. 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. 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.
为了探索美国那些提供 HIV 暴露前预防（PrEP）服务的机构较少的地区，即 PrEP 荒漠。我们从 2017 年的全国 PrEP 服务提供者数据库中获取了公开列出的 PrEP 服务提供者，并从公共数据中获得了男性性行为者（MSM）的县一级城市化分类和人口估计数。我们计算了从普查区到最近服务提供者的出行时间。如果单向驾驶时间大于 30 或 60 分钟，则将普查区划分为 PrEP 荒漠。在有资格接受 PrEP 的 MSM 中，每 8 人就有 1 人（108758/844574；13%）居住在 30 分钟车程的荒漠中，而相当一部分人居住在 60 分钟车程的荒漠中（38804/844574；5%）。南部和较低的城市化水平与 PrEP 荒漠状态的可能性增加密切相关。许多处于 HIV 传播高风险的人生活在没有附近 PrEP 提供者的地方。农村和南部地区受到的影响不成比例。为了最大限度地提高 PrEP 的实施效果，地理位置不应成为获得 PrEP 的决定因素。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。
