Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017

Baugher, Amy; Finlayson, Teresa; Lewis, Rebecca Williamson; Sionéan, Catlainn; Whiteman, Ari; Wejnert, Cyprian

doi:10.2105/ajph.2020.306035

Cited by 21 publications

(23 citation statements)

References 20 publications

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“…The MOR (=1.40) suggests that at least 50% of the odds of PrEP use between multiple pairs of identical individuals living in different states are 40% greater or higher, on average, for individuals living in states with Medicaid expansion. This finding is in line with previously reported effect estimates of PrEP use in relation to Medicaid expansion 16–18. However, our final model ICC indicated that the state of residency of a given participant accounted for only 4% of the variance of PrEP use in our analysis, and the IOR-80 for our Medicaid expansion variables measure of association (ie, OR) included the null value—1.…”

Section: Discussionsupporting

confidence: 91%

“…This finding is in line with previously reported effect estimates of PrEP use in relation to Medicaid expansion. [16][17][18] However, our final model ICC indicated that the state of residency of a given participant accounted for only 4% of the variance of PrEP use in our analysis, and the IOR-80 for our Medicaid expansion variables measure of association (ie, OR) included the null value-1. In MLA, the inclusion of the null value on the IOR-80 indicates that the variable was not relevant to understanding the state-level variation in an individual predisposition to use PrEP.…”

Section: Discussionmentioning

confidence: 80%

“…15 In 2010, the Affordable Care Act (ACA) provided states with the ability to expand Medicaid programmes to adults aged 65 and younger with incomes 138% of the FPL (about $17 000 a year) and below. 15 Several states have chosen to expand Medicaid, and reports have linked increases in PrEP use to these expansions, [16][17][18] suggesting that state variation in PrEP use may explain some of the disparities observed in the population at-large. Thus far, the issue of Medicaid expansion has only been explored on the aggregate level, limiting studies to measures of association which only informs on effect size but not on the impact of the variable on the distribution of PrEP across communities.…”

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

et al. 2022

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ObjectiveTo explore the association of clinical guideline-related variables, demographics and Medicaid expansion on pre-exposure prophylaxis (PrEP) uptake in one of the largest US sample of men who have sex with men(MSM) and transgender and gender non-binary (TGNB) people ever analysed.MethodsWe cross-sectionally analysed predictors of current PrEP use using demographic and HIV risk-related variables (level-1), as well as state-level variables (level-2) (ie, Medicaid expansion status). We further explored the role state of residence plays in PrEP uptake disparities across the USA.ResultsWe found that the odds of PrEP use were significantly greater in older age, white, cisgender men. Moreover, individuals who reported recent post-exposure prophylaxis use, a recent sexually transmitted infection diagnosis and recent drug use were significantly more likely to report PrEP use. Finally, we found that the median odds of PrEP use between similar individuals from different states were 1.40 for the ones living in the Medicaid expansion states, compared with those not living in Medicaid expansion states. State of residence did not play a significant role in explaining PrEP disparities overall.ConclusionOur analysis showed that PrEP use is less common in communities standing to benefit the most from it—young MSM and TGNB of colour. However, individuals meeting federal guidelines for PrEP were significantly more likely to use PrEP. Though we found a positive association between living in Medicaid expansion states and PrEP use; that variable, as well as one’s state of residency, were not suitable to explain variations in PrEP use in the US.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 80%

Section: Strengths and Limitations Of This Studymentioning

confidence: 99%

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Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

et al. 2022

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“…Our findings provide evidence that Medicaid expansion though the Affordable Care Act may have been effective at facilitating PrEP use among the partners of PWH, as has been found for PrEP use in general [36,37]. Although reported partner PrEP use was similar during the 2015 cycle, it increased at higher rates among PWH living in jurisdictions that expanded Medicaid than among those living in jurisdictions that did not, and by the 2019 cycle the prevalence was higher among those in Medicaid expansion states (26.8 vs. 20.4%).…”

Section: Discussionsupporting

confidence: 60%

Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV – United States, May 2015–June 2020

Beer

Tie²,

Dasgupta³

et al. 2022

Aids

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Objective: To estimate trends in the proportion of sexually active U.S. adults with HIV (PWH) reporting an HIV-discordant sexual partner taking preexposure prophylaxis (PrEP) and proportion of partners taking PrEP. Design: The Medical Monitoring Project is a complex sample survey of U.S. adults with diagnosed HIV. Methods: We used annual cross-sectional data collected during June 2015–May 2020 to estimate the annual percentage change (EAPC), overall and by selected characteristics, in reported partner PrEP use among PWH with HIV-discordant partners (N = 8707) and reported PrEP use among these partners (N = 15 844). Results: The proportion of PWH reporting PrEP use by one or more HIV-discordant sex partner rose 19.5% annually (11.3 to 24.4%). The prevalence rose from 6.0 to 17.4% (EAPC, 25.8%) among Black PWH, 10.1 to 26.0% (EAPC, 19.5%) among Hispanic/Latino PWH, and 20.8 to 34.6% (EAPC, 16.3%) among White PWH. Among MSM with HIV, the prevalence increased from 9.6 to 32.6% (EAPC, 28.2%) among Black MSM, 16.6 to 36.0% (EAPC, 15.6%) among Hispanic/Latino MSM, and 24.9 to 44.1% (EAPC, 17.9%) among White MSM. Among HIV-discordant sex partners, the proportion reported to be taking PrEP increased 21.1% annually (7.8 to 18.8%). Reported PrEP use rose from 4.9 to 14.2% (EAPC, 29.9%) among Black partners, 6.5 to 16.8% (EAPC, 20.3%) among Hispanic/Latino partners, and 12.7 to 26.1% (EAPC, 17.0%) among White partners. Conclusions: One in five HIV-discordant sexual partners of PWH was reported to be taking PrEP. PrEP use rose among all examined populations, although the increases did not eliminate disparities in PrEP use.

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“…Multiple studies have found increased PrEP coverage and use in states that expanded Medicaid, and 1 study reported a 5% decrease in the rate of HIV diagnoses among states that expanded Medicaid. 49,100,101 Oral PrEP coverage without cost sharing is now mandatory after the 2019 grade-A recommendation by the U.S. Preventive Services Task Force. 102 The approaching introduction of widespread generic tenofovir/emtricitabine may also impact PrEP costs and uptake.…”

Section: Structural Levelmentioning

confidence: 99%

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

Bonacci

Smith

Ojikutu

2021

American Journal of Preventive Medicine

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Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV acquisition and is a critical tool in the Ending the HIV Epidemic in the U.S. initiative. However, major racial and ethnic disparities across the pre-exposure prophylaxis continuum, secondary to structural inequities and systemic racism, threaten progress. Many barriers, operating at the individual, network, healthcare, and structural levels, impede PrEP access and uptake within Black and Hispanic/Latino communities. This review provides an overview of those barriers and the innovative and collaborative solutions that health departments, healthcare organizations, and community partners have implemented to increase PrEP provision and uptake among disproportionately affected communities. Promising strategies at the individual and network levels focus on increasing patient support throughout the PrEP continuum, positioning and training community members to expand knowledge of and interest in PrEP, and leveraging mobile technologies to support PrEP uptake. Healthcare-level solutions include expanding the venues and types of healthcare professionals that can provide PrEP, and structural-and policylevel options focus on financial assistance programs and health insurance expansion. Key research gaps include demonstrating that pilot studies and interventions remain effective at scale and across varied contexts. Although the last 2 decades have provided effective tools to end the HIV epidemic, realizing this vision for the U.S. will require addressing persistent and pervasive HIV-related disparities in Black and Hispanic/Latino communities. Federal, state, and local partners should expand efforts to address longstanding health and structural inequities and partner with disproportionately affected communities to rapidly expand PrEP scale-up.

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Health Care Coverage and Preexposure Prophylaxis (PrEP) Use Among Men Who Have Sex With Men Living in 22 US Cities With vs Without Medicaid Expansion, 2017

Cited by 21 publications

References 20 publications

Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

Demographic, clinical guideline criteria, Medicaid expansion and state of residency: a multilevel analysis of PrEP use on a large US sample

Trends in preexposure prophylaxis use among sex partners as reported by persons with HIV – United States, May 2015–June 2020

Toward Greater Pre-exposure Prophylaxis Equity: Increasing Provision and Uptake for Black and Hispanic/Latino Individuals in the U.S.

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