HIV Pre-Exposure Prophylaxis Use and Equity in an Urban, Multi-Site Federally Qualified Health Center

Background: Access Community Health Network (ACCESS) is a multi-site network of Federally Qualified Health Centers (FQHCs) located in Chicago that predominately serves Black and Hispanic/Latino patients who experience disproportionate HIV burden. FQHCs must endeavor to provide equitable access to pre-exposure prophylaxis (PrEP) for at-risk patients, but standardized epidemiological methods for assessing PrEP provision in health care settings are lacking. Methods: We compared the demographic characteristics of patients who received at least one PrEP prescription to those of patients who were diagnosed with HIV from January 1, 2023, to December 31, 2024, excluding patients aged <14 years. We divided the number of PrEP users by the number of HIV diagnoses to generate PrEP-to-need Ratios (PnRs), which were used to examine potential disparities by age, gender, race/ethnicity, sexual orientation, and insurance status. We compared patterns of PrEP use at ACCESS to local epidemiological trends using data from AIDSVu. Results: During the study period, the overall PnR among patients was 9.5. In contrast to local PrEP utilization trends, the PnR in patients was negatively associated with age and higher in females (11.3) than males (8.2). We observed higher PnRs among privately insured patients (14.2) than publicly (9.9) and uninsured patients (6.4). Conclusion: To our knowledge, this is one of the first studies to apply the PnR to assess PrEP use and equity in a health care organization. By adapting population-based surveillance strategies to our context, we produced high-quality epidemiological information to drive health equity initiatives.