HIV / STI
Pre-exposure prophylaxis accessibility beyond driving: a case study of Dallas-Fort Worth, Texas Hui Luan* Hui Luan
Spatial accessibility to pre-exposure prophylaxis (PrEP) is associated with PrEP uptake. Existing studies, however, predominantly use driving time or distance to measure PrEP accessibility. Those measures are not optimal from a health equity perspective. Not all people have access to private transportation, and communities at high risk for HIV infections may be more likely to rely on public transit. This study compares driving- and public transit-based PrEP accessibility and relate public transit accessibility with social determinants of health (SDOH) variables in Dallas-Fort Worth, Texas at the Zip Code Tabulation Area (ZCTA) level using Bayesian spatial statistical modeling. Results indicate that disparities exist between driving and public transit travel time to access PrEP providers. By public transit, residents in ZCTAs with higher socioeconomic deprivation or higher HIV risk are more likely to have access to PrEP providers within 30 minutes. In contrast, residents in ZCTAs with higher percentages of Black or Hispanic populations were less likely to have access to PrEP providers within 30 minutes by public transit. Six ZCTAs warrant special attention, because they are in the highest tertile of new HIV diagnosis risks, socioeconomic deprivation, and travel time to the nearest PrEP provider by public transit (>60 minutes). It is insufficient to evaluate PrEP accessibility by driving only. Accounting for different transportation modes in PrEP accessibility is warranted to identify areas most in need of interventions. The Dallas-Fort Worth area should continue its efforts to improve PrEP accessibility to areas with higher percentages of Black and Hispanic populations.