Primary Submission Category: Health care/services
Unequal Access to PrEP in Rural U.S. Counties: Focus on Health Infrastructure and Population Characteristics
Authors: Christine Percheski
Presenting Author: Clay Davis*
Objectives. To introduce a modified PrEP-to-need ratio (PnR) that for the first time captures rural counties in the U.S. and to document PnR variation by health infrastructure and population characteristics among rural county sets.
Methods. We used 2021 PrEP prescriptions and 2019, 2020, and 2021 new HIV diagnoses to calculate PnR for 589 rural county sets. Using descriptive statistics and regression models, we compared county sets across quintiles of PnR on an extensive range of county set demographic, health, and geographic characteristics as well as HIV-specific risk factors and resources.
Results. Rural county sets in Southern regional divisions had considerably lower PnRs (indicating more unmet need) than those elsewhere in the US. County sets in the lowest PnR quintile had more economically disadvantaged residents, more Black residents, and less healthy residents. Those in the lowest PnR quintile were less likely to have a PrEP clinic and more likely to have a prison.
Conclusions. PnR varies widely across rural counties, with lower PnR among county sets with more disadvantaged populations and in Southern states.
Policy Implication. HIV prevention efforts should target PrEP prescriptions in rural, Southern counties with larger black populations.