Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use

Farkhad, Bita Fayaz; Holtgrave, David R.

doi:10.1016/j.amepre.2020.10.021

Cited by 15 publications

(11 citation statements)

References 27 publications

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“…The expansion, which now extends to 38 states, has been associated with modest improvements in PrEP access. 47 Medicaid programs are entitled to statutorily mandated discounts through the Medicaid Drug Rebate Program and have also been able to secure supplemental discounts offered by manufacturers, which have helped to facilitate access to PrEP medications.…”

Section: Prep Access Can Be Improved In the Medicaid Programmentioning

confidence: 99%

Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

Killelea¹,

Johnson²,

Dangerfield³

et al. 2022

J. Law. Med. Ethics

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The U.S. has the tools to end the HIV epidemic, but progress has stagnated. A major gap in U.S. efforts to address HIV is the under-utilization of medications that can virtually eliminate acquisition of the virus, known as pre-exposure prophylaxis (PrEP). This document proposes a financing and delivery system to unlock broad access to PrEP for those most vulnerable to HIV acquisition and bring an end to the HIV epidemic.

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Section: Prep Access Can Be Improved In the Medicaid Programmentioning

confidence: 99%

Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

Killelea¹,

Johnson²,

Dangerfield³

et al. 2022

J. Law. Med. Ethics

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“…Previous literature supports that Medicaid expansions (as well as coverage via private insurance expansions) increase the frequency of regular checkups (Sommers et al., 2017) and HIV screenings (Katz & Jha, 2019). Even though the added health coverage can reduce gonorrhea rates, coverage does not have a significant impact on HIV incidence nor on diagnoses of syphilis or chlamydia (Farkhad et al., 2021). However, there is (limited) evidence that Medicaid expansions cause ex ante moral hazard by lowering the relative risk of sexual activity.…”

Section: Mechanisms and Previous Literaturementioning

confidence: 99%

“…Eilam and Delhommer (2020) show that one additional male PrEP user increases male syphilis, gonorrhea, and chlamydia cases. Since Medicaid expansions increase the number of people with health insurance and they increase utilization of health care services (Lee, 2018), including the use of PrEP (Farkhad et al., 2021), health insurance can have an effect on uptake of prescriptions for those drugs. Therefore, as part of the heterogeneity analysis I investigate whether greater utilization of antiretroviral drugs (HAART, PrEP) leads to differential changes in STI rates for states that have legalized same‐sex marriage.…”

Section: Mechanisms and Previous Literaturementioning

confidence: 99%

Effects of marriage equality legislation on sexual health of the US population

Nikolaou

2022

Health Economics

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Legislation recognizing same-sex marriage has been at the epicenter of public policy during the 2010s. Marriage equality not only increases access for married lesbian, gay, and bisexual (LGB) individuals to federal-level benefits that were previously reserved only for different-sex couples such as health insurance and tax credits, but also contributes to improved attitudes toward LGB individuals. According to the General Social Survey, by 2021 the US population had become more accepting of LGB people with 62.1% reporting that same-sex sexual behaviors are not wrong and 66.4% supporting marriage between same-sex individuals (GSS, 2021)-an increase by 13% and 10% points since 2014, respectively. However, LGB individuals

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“…Furthermore, research demonstrates that lacking health insurance is associated with lengthy delays in the initiation of PrEP care among interested YBMSM13 and may be related to lower PrEP care retention 14–18. Medicaid expansion has been shown to improve engagement in both the antiretroviral treatment (ART) and PrEP continua 19–21. A number of empirical and simulation studies have projected declines in downstream HIV incidence because of improved ART and PrEP continuum engagement 22…”

mentioning

confidence: 99%

“…[14][15][16][17][18] Medicaid expansion has been shown to improve engagement in both the antiretroviral treatment (ART) and PrEP continua. [19][20][21] A number of empirical and simulation studies have projected declines in downstream HIV incidence because of improved ART and PrEP continuum engagement. 22 However, little is known about how Medicaid expansion is likely to impact downstream HIV incidence, particularly in Houston, which remains among the urban epicenters of HIV in the Southern United States.…”

mentioning

confidence: 99%

Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas

et al. 2022

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Context: Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021. Methods: An agent-based model that incorporated the sexual networks of YBMSM was used to simulate improved antiretroviral treatment and pre-exposure prophylaxis (PrEP) engagement through Medicaid expansion in Houston, TX. Analyses considered the HIV incidence (number of new infections and as a rate metric) among YBMSM over the next 10 years under Medicaid expansion as the primary outcome. Additional scenarios, involving viral suppression and PrEP uptake above the projected levels achieved under Medicaid expansion, were also simulated. Results: The baseline model projected an HIV incidence rate of 4.96 per 100 person years (py) and about 368 new annual HIV infections in the 10th year. Improved HIV treatment and prevention continua engagement under Medicaid expansion resulted in a 14.9% decline in the number of annual new HIV infections in the 10th year. Increasing viral suppression by an additional 15% and PrEP uptake by 30% resulted in a 44.0% decline in new HIV infections in the 10th year, and a 27.1% decline in cumulative infections across the 10 years of the simulated intervention. Findings: Simulation results indicate that Medicaid expansion has the potential to reduce HIV incidence among YBMSM in Houston. Achieving HIV elimination objectives, however, might require additional effective measures to increase antiretroviral treatment and PrEP uptake beyond the projected improvements under expanded Medicaid.

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Effect of Medicaid Expansions on HIV Diagnoses and Pre-Exposure Prophylaxis Use

Cited by 15 publications

References 27 publications

Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

Financing and Delivering Pre-Exposure Prophylaxis (PrEP) to End the HIV Epidemic

Effects of marriage equality legislation on sexual health of the US population

Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas

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