Gaps and Determinants in PrEP Uptake and Need: Understanding Disparities in PrEP Among Women in the United States Restricted; Files & ToC

Abstract

Use of daily oral preexposure prophylaxis (PrEP) is a core component of the U.S. Ending the HIV Epidemic Initiative (EHE) and the latest National HIV/AIDS Strategy (NHAS). Although PrEP use has increased significantly since its approval in 2012, there are disparities in uptake by sex, race, and ethnicity in relation to population size and HIV burden. This dissertation examined the factors associated with HIV acquisition among women in the U.S. South, methods to better understand race and ethnicity stratified PrEP use rates, and geographic variation in the sociopolitical and economic characteristics associated with relative changes in PrEP use overall and the PrEP-to-Need ratio (PnR).

In the first study, we developed a predictive risk score for HIV seroconversion among women in the U.S. South. Using LASSO variable selection, we found that a history of bacterial STIs (gonorrhea, chlamydia, trichomoniasis, or syphilis) and behavioral characteristics are associated with increased risk for HIV seroconversion.

In the second study, we compared race and ethnicity stratified PrEP use rate estimates in the U.S. South across three calculation methods – simple imputation, multiple imputation, and multiple imputation with quantitative bias-adjustment. We observed shifts in the direction of the estimated disparity among Black women compared to White women and among Hispanic women compared to White women.

In the third study, we used geographically weighted regression to determine the association of state-level sociopolitical and economic variables with relative changes in PrEP use and PnR. We found both aspatial associations and geographic variation in the associations of the Social Vulnerability Index and baseline PrEP use rate with the relative change in PrEP use from 2017-2022. We found no aspatial association with the relative change in PnR, but we did find geographic variation in some associations.

These findings advance our understanding of risk factors for HIV acquisition among women, methods for determining disparities in PrEP use rates by race and ethnicity, and variation in the characteristics associated with changing PrEP use and PnR by geography.

Table of Contents

This table of contents is under embargo until 21 August 2027

About this Dissertation

Rights statement

• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Laney Graduate School
Department	Epidemiology
Degree	Ph.D.
Submission	Dissertation
Language	English
Research Field	Health Sciences, Epidemiology
Keyword	Missing Data Spatial PrEP HIV Human Immunodeficiency Virus Preexposure Prophylaxis Prediction
Committee Chair / Thesis Advisor	Patrick S. Sullivan, Emory University Jodie L. Guest, Emory University
Committee Members	Jeb Jones, Emory University Lance A. Waller, Emory University

Last modified

Primary PDF

Thumbnail	Title	Date Uploaded	Actions
	File download under embargo until 21 August 2027	2025-08-11 16:15:52 -0400	File download under embargo until 21 August 2027

Supplemental Files

Thumbnail	Title	Date Uploaded	Actions