HIV / STI
Geographic changes in drive time access to pre-exposure prophylaxis (PrEP) in the United States, 2017 to 2024 Noah Mancuso* Noah Mancuso Patrick Sullivan
Background: HIV incidence has fallen drastically in the US in the past decade. However, disparities in uptake of pre-exposure prophylaxis (PrEP) – an HIV prevention drug – exist among several minority populations. Studies have found associations between lower geographic accessibility of PrEP and reduced uptake, which is important given new formulations – like injectable PrEP – require bimonthly administration in-person. Our objective was to assess current drive times to the nearest PrEP provider in each county in the contiguous US and examine changes since the last national analysis (2017).
Methods: Data on PrEP providers was obtained from PrEPLocator. Geospatial analyses calculated the shortest one-way drive time between population-weighted centroids and providers. Counties with drive times >30 minutes were defined as PrEP deserts. Linear regression with natural cubic splines was used to assess differences in drive time by urbanicity controlling for median income, region, and proportion of men who have sex with men (MSM) and racial/ethnic minorities.
Results: Among 3108 counties, median drive time in 2024 was 30.2 minutes, which increased as urbanicity decreased (p-value <0.05). Roughly half (49%) of all counties were PrEP deserts (Figure 1), accounting for 37 million people and 40% of all PrEP-eligible MSM. Drive times in micropolitan/non-metro counties in 2024 were 5-8 times as high as larger metro areas. Between 2017 and 2024, drive time decreased by 29.5 minutes. Predominantly due to lower initial (2017) drive times, the magnitude of change in drive times significantly decreased as urbanicity increased (p-value <0.01).
Conclusions: Most counties have seen sizable reductions in drive time to the nearest PrEP provider. Nonetheless, the ongoing concentration of providers in urban areas has led to persistence of the urban-rural divide. Programs and policies must prioritize expanding PrEP provider access to less urban areas to end the HIV epidemic in the US.