Geographic Density and Uptake of Pre-exposure Prophylaxis (PrEP) Among Young Gay, Bisexual and Other Sexual Minority Men: A Global Positioning System (GPS) Study

Seann D Regan,Denton Callander,Byoungjun Kim,Yen-Tyng Chen,Dustin T Duncan,Basile Chaix

doi:10.1007/s10461-021-03249-1

Abstract

The geographic availability of pre-exposure prophylaxis (PrEP) providers is one important factor that significantly affects PrEP uptake. While most previous studies have employed spatial accessibility in static residential neighborhood definitions or self-reported healthcare accessibility, we examined the associations of the objectively measured geographic density of PrEP services with current PrEP use, using global positioning system (GPS) among sexual minority men (SMM) in New York City. 250 HIV-negative SMM participated in a 2-week GPS monitoring (January 2017–January 2018). Geographic PrEP density was measured as total numbers of PrEP providers in (1) individual activity space defined as daily path area of GPS points, (2) residential street network buffers and (3) census tract and ZIP code of residential locations. Geographic PrEP density within GPS-based activity space was positively associated with current PrEP use (prevalence ratio for 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18]). PrEP provider counts in residential buffer areas and administrative neighborhoods were not associated with PrEP use. Although it is not generalizable beyond New York City, our finding suggests the importance of daily mobility pattern in HIV prevention and PrEP implementation strategies.

Highlights

Despite a recent decline in human immunodeficiency virus (HIV) infection in the general population in the United States (U.S.), young gay, bisexual and other sexual minority men (SMM) face a disproportionately high burden of HIV
This study examines geographic pre-exposure prophylaxis (PrEP) access (i.e. PrEP density) using different neighborhood definitions, and we demonstrate that current PrEP use was positively associated with more PrEP providers in the vicinity, only when the geographic density was measured with global positioning system (GPS)-based activity space definitions (PR for one provided increase 50-m activity space = 1.10, 95% confidence interval: [1.02, 1.18])
The associations are consistent across different buffer sizes of daily path area (DPA) (50, 100, 200 and 400 m), and interestingly, the association is not detected from models considering access in conventional residential areas

Summary

Introduction

Despite a recent decline in human immunodeficiency virus (HIV) infection in the general population in the United States (U.S.), young gay, bisexual and other sexual minority men (SMM) face a disproportionately high burden of HIV. The rate of new HIV diagnoses in 2012 among young SMM aged 13–24 years was more than double the rate in 2002 in the U.S [1]. In 2016, SMM accounted for 81.0% of newly diagnosed HIV infections among individuals aged 13 to 24 years [2]. In 2012, the U.S Food and Drug Administration (FDA) approved daily use of tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for the prevention of sexually-acquired HIV, and it was determined that pre-exposure prophylaxis (PrEP) is an effective biomedical HIV prevention strategy [4,5,6,7]. One multi-site randomized trial found that daily PrEP use significantly reduced the risk of HIV infection (Hazard Ratio: 0.56, p-value: 0.005) among SMM and transgender women [4], and the Center for Disease Control and Prevention (CDC) demonstrated that PrEP reduced the risk of HIV infection by more than 90% among SMM and other vulnerable populations [8]

Methods

Results

Conclusion