Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
Ann Epidemiol. 2021 Dec;64:102-110. doi: 10.1016/j.annepidem.2021.09.006. Epub 2021 Sep 24.
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.
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.
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.
Efforts 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.
居住在与 HIV 暴露前预防 (PrEP) 提供者空间可达性低的地区（即 PrEP 荒漠地区）会导致 PrEP 使用率低。本研究旨在随时间探讨和描述美国 PrEP 可及性的空间分布情况。
我们进行了空间网络分析和地理绘图，以探索持久性 PrEP 荒漠（2016 年和 2020 年可达性较差的普查区）、新 PrEP 荒漠（2020 年可达性较差但 2016 年并非如此的普查区）、新 PrEP 绿洲（2016 年可达性较差但 2020 年并非如此的普查区）和持久性 PrEP 绿洲（2016 年和 2020 年可达性最佳的普查区）的时空分布。我们使用多项式逻辑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。
从 2016 年（28,055 个普查区）到 2020 年（13,240 个普查区），30 分钟 PrEP 荒漠的流行率降低了 52.8%，而 30 分钟 PrEP 绿洲从 2016 年（44,259 个普查区）到 2020 年（59,074 个普查区）增加了 33.5%。在所有普查区中，有 12,487 个（17.3%）为持久性 PrEP 荒漠，753 个（1.0%）为新 PrEP 荒漠，15,568 个（21.5%）为新 PrEP 绿洲，43,506 个（60.1%）为持久性 PrEP 绿洲。总体而言，持久性 PrEP 绿洲在社会经济地位较高、种族/民族多样性较高、位于城市地区以及位于东北部的比例更高，与其他时空 PrEP 可及性类型相比，这种情况在城市和美国人口普查区之间存在差异。
改善 PrEP 可及性的工作应特别侧重于非城市地区和南部、中西部和西部的弱势社区。监测 PrEP 可及性随时间的变化，并确定与这种变化相关的因素，可以帮助评估在改善 PrEP 可及性方面取得的进展。
