Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Dec 12, 2025
Date Accepted: Jan 28, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
The Potential Impact of Federal Funding Cuts on Geographic Access to PrEP in Atlanta, Georgia
ABSTRACT
Background:
Despite major biomedical advances in HIV testing, prevention, and treatment, annual HIV transmissions in the United States remain above 30,000. Geographic access to pre-exposure prophylaxis (PrEP) is critical to HIV prevention efforts, particularly in regions with high HIV burden such as metro-Atlanta. Community-based organizations (CBOs) play a central role in delivering culturally competent prevention services, yet many rely on federal funding that is increasingly unstable. Understanding the potential impact of CBO closures on geographic access to PrEP is essential for anticipating inequities and informing policy.
Objective:
To estimate how hypothetical closures of federally funded CBOs providing PrEP affect geographic access to PrEP clinics by car and public transit across metro-Atlanta, and to assess whether impacts differ by community racial/ethnic composition.
Methods:
We identified 71 PrEP-providing clinics in metro-Atlanta (August 2025), including 12 CBOs. Using three simulated closure scenarios in which 25% of CBOs were randomly closed, we calculated one-way travel times from 2,466 census block group (CBG) centroids to the nearest PrEP providing clinic. Travel times were estimated for car and public transit across three weekdays and timepoints, then averaged per CBG. Logistic regression assessed associations between racial/ethnic plurality and increased travel times.
Results:
Under baseline conditions, 100% of CBGs had car access to a PrEP clinic within 30 minutes, compared to only 42% via public transit. Across closure scenarios, 732 CBGs (30%) – representing over 1 million residents – experienced increased transit times (mean increase: 1.2 minutes; range 0.0–11.6), and 7 CBGs lost transit access entirely. For car travel, 1,184 CBGs (48%) – representing approximately 1.7 million residents – experienced increased drive times (mean increase: 0.5 minutes; range 0.0–6.4). Black-plurality CBGs had higher odds of increased drive times compared to White-plurality CBGs (OR 1.37; 95% CI 1.15–1.63).
Conclusions:
Even limited closure of CBO PrEP providers meaningfully reduces geographic access to HIV prevention services, disproportionately affecting communities already experiencing transportation and HIV-related vulnerabilities. Sustained federal investment in CBOs is essential to preserve equitable PrEP access and prevent avoidable HIV infections. Clinical Trial: N/A
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