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. 2022 Sep;38(4):948-959.
doi: 10.1111/jrh.12645. Epub 2022 Jan 7.

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

J Danielle Sharpe  1 , Travis H Sanchez  1 , Aaron J Siegler  1 , Jodie L Guest  1 , Patrick S Sullivan  1
Affiliations

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

J Danielle Sharpe et al. J Rural Health. 2022 Sep.

Abstract

Purpose: 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.

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 United States.

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 United States are needed to address the growing HIV epidemic in these communities.

Keywords: HIV pre-exposure prophylaxis; accessibility; geographic; men who have sex with men; nonurban.

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Conflict of interest statement

Disclosures: The authors report no conflicts of interest.

References

    1. Centers for Disease Control and Prevention. Kaposi’s sarcoma and pneumocystis pneumonia among homosexual men--new york city and california. MMWR Morb Mortal Wkly Rep. 1981;30(25):305–308. - PubMed
    1. Centers for Disease Control and Prevention. Diagnoses of hiv infection in the united states and dependent areas, 2017. HIV Surveillance Report. 2018;29.
    1. Hall HI, Li J, McKenna MT. Hiv in predominantly rural areas of the united states. J Rural Health. 2005;21(3):245–253. - PubMed
    1. Schafer KR, Albrecht H, Dillingham R, et al. The continuum of hiv care in rural communities in the united states and canada: What is known and future research directions. J Acquir Immune Defic Syndr. 2017;75(1):35–44. - PMC - PubMed
    1. Reif S, Golin CE, Smith SR. Barriers to accessing hiv/aids care in north carolina: Rural and urban differences. AIDS Care. 2005;17(5):558–565. - PubMed

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