Geographic access to HIV pre-exposure prophylaxis (PrEP) in Atlanta, GA: The role of geographic level and mode of transportation Pubblico
Lyland, Audrey (Spring 2020)
Abstract
Background: Disparities in access to HIV pre-exposure prophylaxis (PrEP) are well documented in the United States. Geographic access has commonly been measured with drive time analyses. However, results likely vary based on geographic level (county, census tract, block group) and mode of transportation (driving vs. public transit).
Objectives: To explore the impact of varying the geographic level and mode of transportation on calculated travel times to the nearest PrEP provider. To define areas in the Atlanta Metropolitan Statistical Area (MSA) with limited access to PrEP providers (“PrEP deserts”) and explore associated sociodemographic covariates.
Methods: Population-weighted centroids were obtained for Georgia counties, census tracts, and block groups. PrEP providers were sourced from a publicly available national directory. Travel times were calculated using Google maps API. We defined a PrEP desert as a one-way travel time greater than 30 minutes. We utilized the Brown-Forsythe test to compare median differences and ran multivariable logistic regressions for PrEP desert classification on sociodemographic variables.
Results: Drive times were significantly shorter than public transit times at the census tract and block group levels. There were no differences in median values between geographic levels. Over 30 percent of the Atlanta MSA population resided in a PrEP drive desert. Public transit data was missing for over 60 percent of the population yet in the more central 5-county metropolitan area for which data was available, over 75 percent resided in a PrEP public transit desert. Travel times were shortest in the urban center, and finer levels of geography revealed more nuanced patterns of access. Higher concentrations of Black, Latinx, and high school educated persons were associated with increased odds of PrEP desert classification.
Conclusions: Disparities between public transit and drive times were intensified outside the urban center, potentially indicating a need to improve public transit outside the city center. Finer levels of geography showed more subtle patterns in spatial access across space. However, when analyzing aggregate data, we found limited differences in travel measurements between geographic levels. Given transportation barriers faced by a majority of residents who rely on public transit, alternative options for PrEP access should be considered to improve access.
Table of Contents
Title, Author, Abstract……………………………………….......1
Introduction…………………………………………………….......2
Methods………………………………………………………….......6
Results………………………………………………………….........9
Discussion……………………………………………………….....13
References……………………………………………………….....19
Tables………………………………………………………….........25
Figures…………………………………………………………........31
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Geographic access to HIV pre-exposure prophylaxis (PrEP) in Atlanta, GA: The role of geographic level and mode of transportation () | 2020-04-27 11:49:13 -0400 |
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