Department of Psychology, University of South Carolina, Columbia, South Carolina, and the South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, and the Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina.
AIDS Educ Prev. 2024 Oct;36(5):324-340. doi: 10.1521/aeap.2024.36.5.324.
Despite its efficacy, pre-exposure prophylaxis (PrEP) for HIV has a low uptake, with many disparities remaining. This study aimed to assess the impact of Medicaid expansion and social determinants of health (SDOH) on PrEP prevalence and PrEP-to-need ratio (PnR) using county-level data from 2012 to 2022. Differences-in-differences regressions indicated that Medicaid expansion is associated with increased PnR but not PrEP prevalence. Linear regressions were conducted to evaluate the impact of county-level SDOH on PrEP outcomes. Rurality was associated with lower PnR and PrEP prevalence. Racial disparities were present, with areas with greater concentrations of non-Hispanic Black populations having lower PrEP prevalence and PnR. Greater concentrations of Hispanic populations were associated with lower PnR. Income inequality, socioeconomic status vulnerability, and primary care physician concentration were all associated with higher PnR. Medicaid expansion supports increasing PrEP use in the areas of greatest need. Efforts should be made to improve PrEP access, particularly in areas with high SDOH vulnerabilities.
尽管暴露前预防（PrEP）在防治艾滋病毒方面具有一定效果，但利用率较低，且存在许多差异。本研究旨在利用 2012 年至 2022 年的县级数据，评估医疗补助计划扩大和健康社会决定因素（SDOH）对 PrEP 普及率和 PrEP 需求比（PnR）的影响。差异中的差异回归表明，医疗补助计划扩大与 PnR 的增加有关，但与 PrEP 普及率无关。线性回归用于评估县级 SDOH 对 PrEP 结果的影响。农村地区的 PnR 和 PrEP 普及率较低。存在种族差异，非西班牙裔黑人人口集中的地区 PrEP 普及率和 PnR 较低。西班牙裔人口集中的地区 PnR 较低。收入不平等、社会经济地位脆弱性和初级保健医生集中程度都与更高的 PnR 有关。医疗补助计划扩大支持在最需要的地区增加 PrEP 的使用。应努力改善 PrEP 的获取途径，特别是在社会决定因素脆弱性较高的地区。
