Shi Fanghui, Mi Tianyue, Li Xiaoming, Ning Huan, Li Zhenlong, Yang Xueying
Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA.
Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
J Racial Ethn Health Disparities. 2024 Aug 13. doi: 10.1007/s40615-024-02127-5.
Structural racism contributes to geographical inequalities in pre-exposure prophylaxis (PrEP) coverage in the United States (US). This study aims to investigate county-level variability in PrEP utilization across diverse dimensions of structural racism.
The 2013-2021 nationwide county-level PrEP rate and PrEP-to-need ratio (PNR) data were retrieved from AIDSVu. PrEP rate was defined as the number of PrEP users per 100,000 population, and PNR was defined as the ratio of PrEP users to new HIV diagnoses per calendar year. Linear mixed effect regression was employed to identify associations of county-level structural racism (e.g., structural racism in housing and socioeconomic status) with PrEP rate and PNR on a nationwide scale of the US.
From 2013 to 2021, the mean PrEP rate and PNR increased from 3.62 to 71.10 and from 0.39 to 10.20, respectively. Counties with more structural racism in housing were more likely to have low PrEP rates (adjusted β = - 5.80, 95% CI [- 8.84, - 2.75]). Higher PNR was found in counties with lower structural racism in socioeconomic status (adjusted β = - 2.64, 95% CI [- 3.68, - 1.61]). Regionally, compared to the Midwest region, counties in the West region were more likely to have higher PrEP rate (adjusted β = 30.99, 95% CI [22.19, 39.80]), and counties in the South had lower PNR (adjusted β = - 1.87, 95% CI [- 2.57, - 1.17]).
County-level structural racism plays a crucial role in understanding the challenges of scaling up PrEP coverage. The findings underscore the importance of tailored strategies across different regions and provide valuable insights for future interventions to optimize PrEP implementation.
结构性种族主义导致美国暴露前预防（PrEP）覆盖范围存在地理不平等。本研究旨在调查结构性种族主义不同维度下县级PrEP使用情况的差异。
从AIDSVu获取2013 - 2021年全国县级PrEP使用率和PrEP需求比（PNR）数据。PrEP使用率定义为每10万人口中PrEP使用者的数量，PNR定义为每年PrEP使用者与新HIV诊断病例数的比率。采用线性混合效应回归来确定美国全国范围内县级结构性种族主义（如住房和社会经济地位方面的结构性种族主义）与PrEP使用率和PNR之间的关联。
2013年至2021年，PrEP使用率均值从3.62增至71.10，PNR从0.39增至10.20。住房方面存在更多结构性种族主义的县PrEP使用率较低的可能性更大（调整后β = -5.80，95%置信区间[-8.84, -2.75]）。社会经济地位方面结构性种族主义较低的县PNR较高（调整后β = -2.64，95%置信区间[-3.68, -1.61]）。在区域上，与中西部地区相比，西部地区的县PrEP使用率较高的可能性更大（调整后β = 30.99，95%置信区间[22.19, 39.80]），而南部地区的县PNR较低（调整后β = -1.87，95%置信区间[-2.57, -1.17]）。
县级结构性种族主义在理解扩大PrEP覆盖范围的挑战方面起着关键作用。研究结果强调了针对不同地区制定策略的重要性，并为未来优化PrEP实施的干预措施提供了有价值的见解。
