Location of Pre-exposure Prophylaxis Services Across New York City Neighborhoods: Do Neighborhood Socio-demographic Characteristics and HIV Incidence Matter?
Despite an increasing pre-exposure prophylaxis (PrEP) use among populations at highest risk of HIV acquisition, comprehensive and easy access to PrEP is limited among racial/ethnic minorities and low-income populations. The present study analyzed the geographic distribution of PrEP providers and the relationship between their location, neighborhood characteristics, and HIV incidence using spatial analytic methods. PrEP provider density, socio-demographics, healthcare availability, and HIV incidence data were collected by ZIP-code tabulation area in New York City (NYC). Neighborhood socio-demographic measures of race/ethnicity, income, insurance coverage, or same-sex couple household, were not associated with PrEP provider density, after adjusting for spatial autocorrelation, and PrEP providers were located in high HIV incidence neighborhoods (P < 0.01). These findings validate the need for ongoing policy interventions (e.g. public health detailing) vis-à-vis PrEP provider locations in NYC and inform the design of future PrEP implementation strategies, such as public health campaigns and navigation assistance for low-cost insurance.
KeywordsPre-exposure prophylaxis (PrEP) Neighborhoods Spatial analysis Spatial epidemiology
Mr. Byoungjun Kim was supported in part by the NYU Training Program in Healthcare Delivery Science and Population Health funded by Agency for Healthcare Research and Quality (Grant Number T32HS026120-01; Leora Horwitz, MD and Mark Schwartz, MD, Principal Investigators). Dr. Dustin Duncan was supported in part by grants from the National Institute on Minority Health and Health Disparities (Grant Number R01MD013554), National Institute on Mental Health (Grant Number R01MH112406), National Institute on Drug Abuse (Grant Number R03DA039748) and the Centers for Disease Control and Prevention (Grant Number U01PS005122). We gratefully acknowledge the CDC NPIN for providing the PrEP Locator data. We also wish to thank the anonymous reviewers who offered very helpful comments and suggestions which allowed us to greatly improve our manuscript.
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