Tran Jacinda, Mishra Anu, Zimmermann Marita, Hansen Ryan
J Am Pharm Assoc (2003). 2025 Mar-Apr;65(2):102274. doi: 10.1016/j.japh.2024.102274. Epub 2024 Oct 24.
Pre-exposure prophylaxis (PrEP) is key to ending the US HIV epidemic, but uptake remains low. Federal legislation permitting community pharmacists to initiate PrEP nationwide could expand access to PrEP services.
This study aimed to evaluate census tract-level geospatial access to PrEP facilities and community pharmacies across the US and characterize geographic areas and populations where community pharmacies could help bridge the gap in care.
We identified census tracts with limited or no access ("deserts") to PrEP facilities and community pharmacies in 2022 using 2 primary definitions: 1) a tract with no PrEP facilities or pharmacies within a 30-minute drive of the tract centroid; and 2) a tract with low income and low access (no PrEP facilities or pharmacies within one mile of the centroid for low vehicle access tracts, 2 miles in urban tracts, 10 miles in suburban tracts, 20 miles in rural tracts). Tracts with access were "oases," and "PrEP desert, pharmacy oasis" tracts represented areas without PrEP facilities where community pharmacies could expand access. We characterized the social determinants of health associated with desert status and conducted sensitivity analyses exploring additional access definitions.
Of the 82,729 census tracts in our analysis, most were classified as dual PrEP and pharmacy oases. We categorized 13.3% as PrEP deserts under the 30-minute definition, and 94.3% of these tracts were pharmacy oases. Under the low income and low access definition, 17.0% of all tracts were PrEP deserts, 78.2% of which were pharmacy oases. PrEP deserts were predominantly located in the Midwest and South and associated with higher poverty, social vulnerability, and uninsurance.
Our analysis confirmed inequitable access to PrEP facilities across the US. Federal recognition of pharmacists as health care providers empowered to initiate PrEP nationwide has the potential to substantially bridge access gaps for underserved communities.
暴露前预防（PrEP）是终结美国艾滋病流行的关键，但使用率仍然很低。允许社区药剂师在全国范围内开展PrEP的联邦立法可能会扩大PrEP服务的可及性。
本研究旨在评估美国各普查区层面获得PrEP设施和社区药房的地理空间可及性，并描述社区药房可帮助弥合护理差距的地理区域和人群特征。
我们在2022年使用两种主要定义确定了获得PrEP设施和社区药房的机会有限或没有机会（“荒漠”）的普查区：1）在距普查区中心30分钟车程内没有PrEP设施或药房的区域；2）低收入且可及性低的区域（对于车辆通行率低的区域，在距中心一英里内没有PrEP设施或药房；在城市区域为两英里；在郊区为十英里；在农村区域为二十英里）。有可及性的区域为“绿洲”，“PrEP荒漠，药房绿洲”区域代表没有PrEP设施但社区药房可扩大可及性的区域。我们描述了与荒漠状态相关的健康社会决定因素，并进行了敏感性分析，探索其他可及性定义。
在我们分析的82,729个普查区中，大多数被归类为PrEP和药房双绿洲。根据30分钟定义，我们将13.3%归类为PrEP荒漠，其中94.3%的区域是药房绿洲。根据低收入和低可及性定义，所有区域的17.0%是PrEP荒漠，其中78.2%是药房绿洲。PrEP荒漠主要位于中西部和南部，与更高的贫困、社会脆弱性和未参保率相关。
我们的分析证实了美国各地获得PrEP设施的机会不平等。联邦政府承认药剂师为有权在全国范围内开展PrEP的医疗保健提供者，这有可能大幅弥合服务不足社区的可及性差距。
