Background
Despite increasing pre-exposure prophylaxis (PrEP) utilization, access to providers offering PrEP services remains limited and unevenly distributed across the US. This study leveraged a novel linkage of commercial and public datasets to examine socioeconomic and geographic disparities in PrEP provider availability.
Methods
Providers who prescribed ≥1 PrEP regimen from 2021 to 2023 were identified using the IQVIA LAAD claims database. This dataset was linked with (1) Zip Code Tabulation Area-level demographic data from the Census 2020 and the American Community Survey 2018–2023 estimates, and (2) county-level primary care provider data from the County Health Rankings & Roadmaps. At multiple US geographic levels, we evaluated the ratio of PrEP providers to (1) PrEP users and (2) all primary care providers, as well as (3) the mean proportion of PrEP claims dispensed.
Results
The number of PrEP providers increased from 64,790 in 2021 to 75,371 in 2022 and 83,708 in 2023. Most providers were nurse practitioners/physician assistants (36.5%) or family medicine physicians (30.1%). Most providers practiced in predominantly White neighborhoods (65.1%), with only 4.7% in predominantly Black and 7.7% in predominantly Hispanic neighborhoods; 12.5% practiced in low-income neighborhoods. Although the ratio of PrEP providers to primary care providers increased over time (0.27 in 2021 to 0.34 in 2023), the ratio of PrEP providers to PrEP users remained steady (0.23 in 2021 to 0.22 in 2023), and substantial geographic variation persisted. ‘Ending the HIV Epidemic’ (EHE) regions had a lower ratio of PrEP providers to users (0.16) versus non-EHE jurisdictions (0.31) in 2023. Rates of dispensed PrEP claims were higher for providers in the Northeast (83%) than in other regions (77–79%). Southern states, where HIV prevalence is high, had low PrEP provider availability; in particular, Alabama had a very low ratio of PrEP providers to primary care providers, and Florida and Texas had very low ratios of PrEP providers to PrEP users (Figure).
Conclusions
This is the first study to illustrate socioeconomic and geographic disparities in PrEP provider availability in the US. The disproportionate growth of PrEP users relative to providers and low ratios of providers in high HIV incidence regions underscore the urgent need to improve access to HIV prevention services. Ensuring equitable PrEP access for key populations across geographies is critical for addressing these disparities and combating the HIV epidemic.