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

• Authors: J. Danielle Sharpe, Emory University; Travis Sanchez, Emory University; Aaron J Siegler, Emory University; Jodie L. Guest, Emory University; Patrick S Sullivan, Emory University
• Journal Title: Journal of Rural Health
• Publisher: John Wiley and Sons | 2022-01-07
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/jrh.12645
• Subjects: Health Sciences, Epidemiology
• Keywords: accessibility; geographic; HIV pre-exposure prophylaxis; men who have sex with men; nonurban

Abstract

Purpose: The U.S. 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. Methods: 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 U.S. Findings: 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. Conclusions: Structural interventions designed to decrease barriers to PrEP access that are unique to nonurban areas in the U.S. are needed to address the growing HIV epidemic in these communities.