Abstract
OBJECTIVE: Assess current drive times to the nearest pre-exposure prophylaxis (PrEP) provider in each county in the contiguous United States (US) and examine changes since the last analysis (2017).
METHODS: PrEP provider data were obtained from PrEPLocator.org in March 2025. Geospatial analyses calculated one-way drive times from population-weighted county centroids to the nearest provider. Counties with drive times >30 min were defined as PrEP deserts. Linear regression assessed variation in drive times by urbanicity and region, adjusting for median income, small-area population estimates of men who have sex with men (MSM), and proportion of racial/ethnic minority populations.
RESULTS: In 2025, median drive time was 30.2 min, increasing with decreasing urbanicity (p < 0.05). Half of counties were PrEP deserts, accounting for 36 million residents and 4 % of PrEP-eligible MSM. Drive times in micropolitan/non-core counties were 5-8 times higher than in large metro counties. Between 2017 and 2025, the US South had the largest relative reduction in drive time: however, relative changes did not significantly differ by urbanicity.
CONCLUSIONS: While PrEP access has improved nationally, important geographic disparities remain. Programs and policies must prioritize expanding access to PrEP to less urban areas to end the HIV epidemic in the US.