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Association between the geographic accessibility of PrEP and PrEP use among MSM in nonurban areas.

Authors
  • Sharpe, J Danielle1
  • Sanchez, Travis H1
  • Siegler, Aaron J1
  • Guest, Jodie L1
  • Sullivan, Patrick S1
  • 1 Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA. , (Georgia)
Type
Published Article
Journal
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
Publication Date
Sep 01, 2022
Volume
38
Issue
4
Pages
948–959
Identifiers
DOI: 10.1111/jrh.12645
PMID: 34997634
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The US HIV epidemic has become a public health issue that increasingly affects men who have sex with men (MSM), including those residing in nonurban areas. Increasing access to pre-exposure prophylaxis (PrEP) in nonurban areas will prevent HIV acquisition and could address the growing HIV epidemic. No studies have quantified the associations between PrEP access and PrEP use among nonurban MSM. Using 2020 PrEP Locator data and American Men's Internet Survey data, we conducted multilevel log-binomial regression to examine the association between area-level geographic accessibility of PrEP-providing clinics and individual-level PrEP use among MSM residing in nonurban areas in the United States. Of 4,792 PrEP-eligible nonurban MSM, 20.1% resided in a PrEP desert (defined as more than a 30-minute drive to access PrEP), and 15.2% used PrEP in the past 12 months. In adjusted models, suburban MSM residing in PrEP deserts were less likely to use PrEP in the past year (adjusted prevalence ratio [aPR] = 0.35; 95% confidence interval [CI] = 0.15, 0.80) than suburban MSM not residing in PrEP deserts, and other nonurban MSM residing in PrEP deserts were less likely to use PrEP in the past year (aPR = 0.75; 95% CI = 0.60, 0.95) than other nonurban MSM not residing in PrEP deserts. Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the United States are needed to address the growing HIV epidemic in these communities. © 2022 National Rural Health Association.

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