Spatial Analysis of PrEP Access via Public Transit and Car in Urban Areas Across Demographic Variables and Clinic Services Público

Abstract

Background:

New HIV diagnoses have declined over the past decade, but men who have sex with men (MSM) remain disproportionately impacted by new diagnoses. Disparities persist despite availability of oral pre-exposure prophylaxis (PrEP), with access being a major inhibitor to uptake. While previous studies have examined issues related to access to PrEP, this study expands on those findings by examining access to PrEP via public transportation.

Methods:

Census tract shapefiles and population weighted centroids for the cities of Washington, DC; Atlanta, GA; and Jackson, MS were obtained from the U.S. Census Bureau. Demographic information was collected for census tracts from the 2016 American Community Survey (ACS), and county-level MSM estimates were obtained through a data request to the ACS, which were assigned down to the census tract level. Information for PrEP-prescribing clinics was obtained from the National Prevention Information Network (NPIN). Data were imported into ArcGIS 10.6, which was used to produce neartables of the nearest clinic to each centroid. Coordinates from these neartables were then submitted to the Google Maps API, which determined public transit and driving times between each centroid and its nearest clinic. These times were then used to produce travel time maps while SAS 9.4 was used to conduct descriptive analyses using demographic data for each census tract.

Results:

While all three cities showed little difficulty in access via car, there were several PrEP deserts when examining access via public transportation. Suburban areas of each city displayed more areas with transit times greater than 50 minutes to the nearest clinic, and these areas became larger when only considering clinics with PrEP navigator services or accepting uninsured patients. Greater numbers of census tracts with higher rates of uninsured individuals or higher proportions of Hispanic individuals were associated with requiring greater than 50 minutes of transit time to their nearest clinic.

Conclusions:

PrEP deserts are just as much an issue in urban areas as they have been in rural areas when considering public transit. Structural interventions need to be taken to provide better access to PrEP clinics via public transportation, especially for uninsured and Black and Hispanic populations.

Table of Contents

Introduction................................................................................................... 1

Methods......................................................................................................... 4

PrEP Clinic Data............................................................................... 4

Demographic Data............................................................................. 4

PrEP Eligibility Data......................................................................... 5

Geographic Data and Methods.......................................................... 5

Descriptive Analyses......................................................................... 6

Results........................................................................................................... 7

Initial and Final Analysis Areas........................................................ 7

Population and Clinic Distributions.................................................. 7

Driving and Transit Times for All PrEP-Prescribing Clinics........... 9

Driving and Transit Times for PrEP-Prescribing Clinics with

           PrEP Navigation Services..................................................... 10

Driving and Transit Times for PrEP-Prescribing Clinics

          Accepting Uninsured Patients................................................ 12

Median Travel Time by City............................................................. 13

Discussion..................................................................................................... 15

Limitations......................................................................................... 18

Conclusion......................................................................................... 19

References..................................................................................................... 20

Table 1........................................................................................................... 22

Table 2........................................................................................................... 23

Table 3........................................................................................................... 24

Table 4........................................................................................................... 25

Table 5........................................................................................................... 26

Table 6........................................................................................................... 27

Figure 1.......................................................................................................... 28

Figure 2.......................................................................................................... 29

Figure 3.......................................................................................................... 30

Figure 4.......................................................................................................... 31

Figure 5.......................................................................................................... 32

Figure 6.......................................................................................................... 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.S.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	Healthcare Access HIV GIS PrEP
Committee Chair / Thesis Advisor	Siegler, Aaron, Emory University

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