TOWARDS ENDING THE HIV EPIDEMIC ONE COUNTY AT A TIME AN EVALUATION FRAMEWORK FOR SUBCOUNTY-LEVEL USAGE OF PRE-EXPOSURE PROPHYLAXIS FOR EXPOSING DISPARITIES AND GUIDING TARGETED INTERVENTIONS

About 1.1 million Americans were living with HIV in 2019, with the total lifetime cost to treat a single person with an HIV infection estimated to be around $501,000. PrEP, a pill taken daily by mouth, contains antiretroviral drugs and is highly effective in preventing the acquisition of HIV. Even though PrEP coverage in the US improved from 9% in 2016 to 18% in 2018, considerable disparities in PrEP prescriptions exist in different geographic, racial/ethnic, and age groups. Existing metrics to measure PrEP overestimates PrEP coverage. Moreover, previous studies conducted at the national and state levels often fail to capture disparities in PrEP use within the county and cannot be used by county public health officials to conduct targeted interventions. This dissertation establishes an evaluation framework for HIV prevention by measuring PrEP usage at subcounty levels.
The PrEP coverage increased annually throughout the study period in the county. The G2ZMC PHI had a significant gradual effect of about nine PrEP patients every month. The results of this dissertation quantified and identified opportunities for improvement in PrEP use in underserved groups. This work can be extended to other counties and provide a foundation for similar studies on other emerging infectious diseases.