HIV / STI
A geospatial analysis of public transit access to HIV pre-exposure prophylaxis (PrEP) providing clinics in metro-Atlanta Noah Mancuso* Noah Mancuso Patrick Sullivan
Background: Young Black and Hispanic men experience high HIV incidence in the US and rely on public transit more than White men. HIV pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention method, but challenges with access remain. We describe public transit access to PrEP providing clinics in the metro-Atlanta region.
Methods: Census block groups (CBGs) from four Atlanta counties were joined with CBG-level sociodemographic data from the 2016-2020 American Community Survey. PrEP clinics in Georgia were identified in a national directory. Population-weighted centroids of each CBG were used to calculate the 10 closest PrEP clinics; the Google Maps Distance Matrix API was used to calculate travel time by public transit. CBGs were considered public transit deserts if no public transit option was available or if transit time was >45 minutes. Multivariable log-binomial regression was used to describe associations between public transit deserts and CBG-level race, ethnicity, age, and income.
Results: Of the 2,466 Atlanta CBGs, 23% had no access to a PrEP clinic by public transit. The average transit time to the nearest PrEP clinic was 37 minutes; 489 CBGs housing 729,941 residents had transit times >45 minutes. A 5% increase in the proportion of males aged 25-34; of people living under the poverty line; or of Hispanic people living in a CBG were each associated with a decreased prevalence of being defined as a public transit desert [aPR=0.61 (0.56, 0.66); aPR=0.75 (0.71, 0.78); aPR=0.96 (0.94, 0.98)]. There was no association with Black race.
Conclusion: Many Atlantans do not have access to a PrEP clinic by public transit. Public transit access to PrEP is better for CBGs with more HIV prevention priority populations. To increase PrEP access in public transit deserts, the geographic spread of PrEP clinics should be expanded, travel subsidiaries should be provided for ride-sharing services, and telemedicine and pharmacy PrEP programs should be widely available.
