Sage prep spatial availability and geospatial exploration of injectable prep services

The National Institute of Allergy and Infectious Diseases awarded Emory University $100,228 on September 30, 2026, under the Allergy and Infectious Diseases Research program (CFDA 93.855) to conduct spatial analysis of long-acting injectable pre-exposure prophylaxis (LAI-PrEP) service availability across the United States.

The project, titled SAGE PREP (Spatial Availability and Geospatial Exploration of Injectable PrEP Services), integrates clinic location data from an expanded PREP Locator 2.0 platform with line-level prescription data from Symphony Health and publicly available federal neighborhood-level datasets to examine how geographic and social factors affect LAI-PrEP availability, uptake, and persistence. Research activities include describing the distribution of LAI-PrEP clinics and identifying LAI-PrEP deserts—areas without service provision within 30 minutes' travel—as well as conducting logistic regression analyses to characterize sociodemographic and spatial characteristics associated with specialized services offered by clinics in census tracts served by LAI-PrEP providers.

Work is performed at Emory University in Atlanta, Georgia, with a period of performance through September 29, 2029. The award is classified as a Project Grant under the assistance type.

Abstract

Long-acting injectable pre-exposure prophylaxis to prevent HIV (LAI-prep) is superior to oral prep at preventing HIV infection. Strong overall preference for LAI-prep compared to oral prep has been reported since its approval in 2021. The currently approved LAI-prep, cabotegravir, requires injections be administered by a provider every two months, making geographic access a crucial component of care. Currently, geographic availability of LAI-prep in the united states is unclear, but previous work by our team on oral prep found that counties with a higher prevalence of poverty were more likely to have a trip of 30 minutes or greater drive time to the nearest prep clinic. Persistence is a critical component of oral prep effectiveness, and discontinuing users are at elevated risk of HIV and may be excellent candidates for LAI- prep. LAI-prep has the potential to substantially reduce HIV incidence in populations disproportionately burdened by HIV, but only if IT is geographically available. Our team is expanding prep locator into prep locator 2.0, which will include oral and LAI-prep providing clinics in the united states and will be a key data source in this project. We will be integrating prep locator 2.0 with line-level prep prescription data from symphony health and publicly available federal datasets containing neighborhood characteristics to address gaps in our understanding of how geographic and social factors impact LAI-prep availability, uptake, and persistence. In aim 1A, we will describe the distribution of LAI-prep clinics and, in census tracts with a clinic, conduct a series of logistic regression analyses to describe sociodemographic and spatial characteristics associated with specialized services offered by the clinic. In aim 1B, we will describe the distribution of LAI-prep deserts, defined as areas with no service provision within 30 minutes one-way driving time, and conduct multivariable logistic regression analyses of these deserts to describe associated census tract-level demographic and spatial characteristics. We will also quantify the number of prep-eligible persons living in these deserts. In aim 2, we will characterize prep use trajectories and evaluate the association between oral prep non-persistence and LAI-prep initiation. In aim 3, we will use a bayesian hierarchical spatial regression model to examine the relationship between LAI- prep geographic availability and uptake. This research project will illustrate how LAI-prep is being brought to scale in the united states and inform our understanding of who is able to or interested in initiating LAI-prep. We hope that this research aids in prioritization of resources and training to providers that serve populations at greatest risk of HIV.