Is Insurance a Barrier to HIV Preexposure Prophylaxis? Clarifying the Issue

Kay, Emma Sophia; Pinto, Rogério M.

doi:10.2105/ajph.2019.305389

Cited by 84 publications

(62 citation statements)

References 20 publications

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“…Access and cost are key known barriers to PrEP in the United States, Europe, and Australia [ 5 , 6 ]. Additionally, UNAIDS has indicated that having PrEP in a select group of centers is a barrier to PrEP service delivery due to the long distances to these facilities and attendant transport costs [ 25 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

“…PrEP is currently being implemented globally with varying degrees of interest among MARPs. Acceptability of PrEP in the United States, Europe, and Australia has been high among MSM, despite access and cost barriers [ 5 , 6 ]. Data on PrEP acceptability in sub-Saharan Africa are limited; however, a few studies have shown high acceptability among MSM [ 7 , 8 ] and variable acceptability and adherence among adolescent girls and young women [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

et al. 2020

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Background Scale-up of oral pre-exposure prophylaxis (PrEP) for HIV prevention in Uganda began with serodiscordant couples (SDC) and has expanded to other most at-risk populations (MARPs). We explored knowledge, acceptability, barriers and facilitators of PrEP use among potential PrEP users in four MARPs (SDC; men who have sex with men [MSM]; female sex workers [FSW], and fisher folk). Methods We administered quantitative surveys to potential PrEP users in multiple settings in Central Uganda at baseline and approximately 9 months after healthcare worker (HCW) training on PrEP. Results The survey was completed by 250 potential PrEP users at baseline and 125 after HCW training; 55 completed both surveys. For these 250 participants, mean age was 28.5 years (SD 6.9), 47% were male and 6% were transgender women, with approximately even distribution across MARPs and recruitment locations (urban, peri-urban, and rural). Most (65%) had not heard about PrEP. After HCW training, 24% of those sampled were aware of PrEP, and the proportion of those who accurately described PrEP as “antiretrovirals to be used before HIV exposure” increased from 54% in the baseline survey to 74% in the second survey (p<0.001). The proportion of participants who reported HCW as a source of PrEP information increased after training (59% vs 91%, p<0.001). In both surveys, nearly all participants indicated they were willing to take PrEP if offered. The most common anticipated barriers to PrEP were stigma, transportation, accessibility, busy schedules, and forgetfulness. Closeness to home was a common facilitator for all participant categories. Conclusions Initial awareness of PrEP was low, but PrEP knowledge and interest increased among diverse MARPs after HCW training. Demand creation and HCW training will be critical for increasing PrEP awareness among key populations, with support to overcome barriers to PrEP use. These findings should encourage the acceleration of PrEP rollout in Uganda.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

et al. 2020

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“…At present, many existing PrEP navigation services support individuals in initiating PrEP (e.g., providing information on accessing medication assistance programs, answering questions about using PrEP, disseminating information on where to access PrEP, accompanying individuals to initial PrEP medical visit). This service should be expanded to include PrEP retention efforts after initiation, as some of the barriers or challenges to starting PrEP are the same for remaining on PrEP (e.g., lack or lapse of insurance, cost, side effects) [40][41][42][43]. Case management, which has been shown to be effective in managing HIV care, is another option to support PrEP users [44][45][46].…”

Section: A Need For Prep Support Servicesmentioning

confidence: 99%

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

et al. 2020

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Purpose Disparities persist in HIV infection among Black and Latino men who have sex with men (BLMSM) and Black and Latina transgender women (BLTW). Increasing uptake and subsequent consistent use of pre-exposure prophylaxis (PrEP), an effective biomedical strategy for preventing HIV acquisition, can dramatically reduce HIV incidence in these populations. The purpose of this study was to explore reasons for PrEP discontinuation among BLMSM and BLTW living in Los Angeles County to inform the development of support services for these populations to remain persistent with their PrEP regimen. Methods In-depth, semi-structured interviews were conducted with 15 BLMSM and 7 BLTW who reported either temporary or indefinite PrEP discontinuation. A thematic analysis approach was used to analyze qualitative data. Results Four themes emerged related to reasons for PrEP discontinuation, including: (1) lower perceived HIV risk related to changes in sexual behavior; (2) structural or logistical barriers (e.g., lapse or loss of health insurance, cost, difficulty navigating complex medical systems); (3) anticipated and experienced medication side effects, with a sub-theme of interactions between PrEP and feminizing hormone medications; and (4) challenges with medication adherence. Conclusions PrEP is an important prevention tool for BLMSM and BLTW, particularly during periods of heightened HIV risk. However, both individual (e.g., inability to adhere to medication, changes in HIV sexual risk behaviors) and structural/logistical (e.g., loss of insurance, navigating complex medical systems) factors can cause temporary or indefinite PrEP discontinuation. Additional support services, beyond those offered by medical providers, are needed to help BLMSM and BLTW PrEP users overcome barriers to discontinuation and assist them to remain persistent with their PrEP regimen. We describe potential options for support services such as PrEP case management, expanded PrEP navigation services, or text messaging services.

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“…7,8 While ensuring adequate health insurance is not an explicit part of the federal government's Ending the HIV Epidemic, 9 health insurance has impacts on access to HIV care, 10 access to ART, 11,12 achievement of viral suppression, [13][14][15] and access to PrEP. 16 Access to HIV care and viral suppression are associated with improved morbidity and mortality for the individual. 17,18 For PLWH, insurance has also been associated with a survival benefit.…”

Section: Introductionmentioning

confidence: 99%

“…[19][20][21][22] For those at increased risk for HIV, lack of health insurance is a barrier to PrEP access. 16 In addition, lack of health insurance has been associated with delayed PrEP initiation despite available patient assistance programs and any delay in initiation can result in preventable HIV infections. 23 Moreover, PrEP-related out-of-pocket costs can vary widely depending on one's insurance, 24 and high PrEP-related costs are a barrier to PrEP use.…”

Section: Introductionmentioning

confidence: 99%

Assisters Succeed in Insurance Navigation for People Living with HIV and People at Increased Risk of HIV in a Complex Coverage Landscape

McManus

Killelea

Honeycutt

et al. 2020

AIDS Research and Human Retroviruses

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Insurance enrollment is complex for people living with HIV (PLWH) and people at increased risk for HIV, in part, owing to needing to ensure access to adequate provider networks and appropriate formularies. Insurance for PLWH facilitates access to HIV care/treatment and, ultimately, viral suppression, which has the individual benefit of longevity and the public health benefit of decreased HIV transmission. For people at increased risk for HIV, access to insurance facilitates improved access to HIV biomedical prevention, which has the individual benefit of elimination of transmission risk and the public health benefit of decreased HIV transmission. The objective of this study was to explore perceptions of priorities related to plan navigation, barriers and facilitators for enrolling and maintaining insurance coverage, and questions related to regional, state, and federal policies impacting plans provided both on and off the Affordable Care Act (ACA) marketplace. We interviewed a national sample of assisters (n = 40), who specialize in insurance plan selection for these populations. We found that assisters tailor their approaches to HIV-specific and person-specific concerns by navigating challenges related to affordability, formularies, and provider networks. In a complex coverage landscape during a time of uncertainty about the long-term future of the ACA, assisters have mastered the ability to simplify the insurance selection process for a vulnerable population. Assisters have excelled at incorporating insurance literacy education and encouraging client engagement in the process. Assisters play an essential role in the current complicated and fragmented United States' health care delivery system for PLWH and people at increased risk for HIV and could be incorporated into the Ending the HIV Epidemic initiative.

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Is Insurance a Barrier to HIV Preexposure Prophylaxis? Clarifying the Issue

Cited by 84 publications

References 20 publications

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

Knowledge and barriers of PrEP delivery among diverse groups of potential PrEP users in Central Uganda

PrEP discontinuation among Latino/a and Black MSM and transgender women: A need for PrEP support services

Assisters Succeed in Insurance Navigation for People Living with HIV and People at Increased Risk of HIV in a Complex Coverage Landscape

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