The Impact of Insurance on HIV Testing

Sood, Neeraj; Wagner, Zachary; Wu, Yanyu

doi:10.1162/ajhe_a_00028

Cited by 15 publications

(12 citation statements)

References 32 publications

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“…Our finding also highlights the significance of health care coverage to uptake of HIV testing in the United States. 49 HIV testing for pregnant women has been recommended by the United States Preventive Services Task Force as grade ‘A’ preventive service, and hence it is provided by most insurers without cost-sharing under the Affordable Care Act. 50…”

Section: Discussionmentioning

confidence: 99%

HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011–2017 National Survey of Family Growth

2020

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Although there has been significant progress in reducing perinatal human immunodeficiency virus (HIV) transmission, the United States is yet to meet the proposed elimination goal of less than one infection per 100,000 live births. Failure to screen all pregnant women for HIV as recommended by the Centers for Disease Control and Prevention can result in missed opportunities for preventing vertical transmission of HIV with antiretroviral drugs. Using the 2011–2017 National Survey of Family Growth, this study examined HIV testing among pregnant women during prenatal care. We estimated the weighted proportion of self-reported HIV testing among women whose last pregnancy ended within 12 months prior to the interview. Logistic regression models were used to determine the factors associated with HIV testing. Of the 1566 women included in the study, 76.4% (95% confidence intervals [CI] = 72.8–80.0) reported receiving an HIV test during prenatal care. In the multivariable regression model, high school diploma (adjusted odds ratio [aOR] = 1.9, 95% CI = 1.1–3.1), two completed pregnancies (aOR = 1.7, 95% CI = 1.1–2.7), health insurance coverage in the last 12 months (aOR = 1.6, 95% CI = 1.0–2.6), Hispanic race/ethnicity (aOR = 2.8, 95% CI = 1.8–4.4), and non-Hispanic black race/ethnicity (aOR = 2.2, 95% CI = 1.3–3.8) were associated with higher odds of reporting being tested for HIV. However, household income of 300% or more of the federal poverty level (aOR = 0.6, 95% CI = 0.3–0.9) and urban residence (aOR = 0.5, 95% CI = 0.3–0.9) were associated with lower odds of reporting HIV testing. These findings suggest that HIV testing among pregnant women during prenatal care is not universal and may affect achieving the goal of elimination of mother-to-child transmission of HIV in the United States.

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Section: Discussionmentioning

confidence: 99%

HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011–2017 National Survey of Family Growth

2020

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“…Private health insurance plans are also required to provide appropriate care to those enrolled in their plans and in most cases are more effective than public insurance [30]. Additionally, health insurance has greatly influenced HIV testing, with insurance coverage increasing HIV testing rates more so among high-risk populations [31], and containing the epidemic among those without insurance [32]. In Europe, just like the US, both public resources and private health insurance offers coverage for citizens living with HIV [33,34].…”

Section: Introductionmentioning

confidence: 99%

Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention

Were

Hogan

Galárraga

et al. 2020

IJERPH

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Background: The global push to achieve the 90-90-90 targets designed to end the HIV epidemic has called for the removing of policy barriers to prevention and treatment, and ensuring financial sustainability of HIV programs. Universal health insurance is one tool that can be used to this end. In sub-Saharan Africa, where HIV prevalence and incidence remain high, the use of health insurance to provide comprehensive HIV care is limited. This study looked at the factors that best predict social health insurance enrollment among HIV positive pregnant women using data from the Academic Model Providing Access to Healthcare (AMPATH) in western Kenya. Methods: Cross-sectional clinical encounter data were extracted from the electronic medical records (EMR) at AMPATH. We used univariate and multivariate logistic regressions to estimate the predictors of health insurance enrollment among HIV positive pregnant women. The analysis was further stratified by HIV disease severity (based on CD4 cell count <350 and 350>) to test the possibility of differential enrollment given HIV disease state. Results: Approximately 7% of HIV infected women delivering at a healthcare facility had health insurance. HIV positive pregnant women who deliver at a health facility had twice the odds of enrolling in insurance [2.46 Adjusted Odds Ratio (AOR), Confidence Interval (CI) 1.24–4.87]. They were 10 times more likely to have insurance if they were lost to follow-up to HIV care during pregnancy [9.90 AOR; CI 3.42–28.67], and three times more likely to enroll if they sought care at an urban clinic [2.50 AOR; 95% CI 1.53–4.12]. Being on HIV treatment was negatively associated with health insurance enrollment [0.22 AOR; CI 0.10–0.49]. Stratifying the analysis by HIV disease severity while statistically significant did not change these results. Conclusions: The findings indicated that health insurance enrollment among HIV positive pregnant women was low mirroring national levels. Additionally, structural factors, such as access to institutional delivery and location of healthcare facilities, increased the likelihood of health insurance enrollment within this population. However, behavioral aspects, such as being lost to follow-up to HIV care during pregnancy and being on HIV treatment, had an ambiguous effect on insurance enrollment. This may potentially be because of adverse selection and information asymmetries. Further understanding of the relationship between insurance and HIV is needed if health insurance is to be utilized for HIV treatment and prevention in limited resource settings.

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“…This finding is consistent with past research suggesting that health coverage increases the rate of HIV testing (and thus the rate of diagnoses 31 ), particularly among high-risk populations. 32 Past research has suggested that marijuana use, either recreationally or in the context of sex, is an important risk factor for the transmission of both HIV and STIs among high-risk populations. 33 Other research has also shown that those who use marijuana either recreationally or as a sex-drug are less likely to be aware of their HIV-positive status 22 and more likely to participate in HIV risk behaviors, such as group sex and condomless sex, respectively.…”

Section: Discussionmentioning

confidence: 99%

Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals?

Morgan

Skaathun

Duvoisin

et al. 2018

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Debate remains as to the relative HIV transmission contributions from individuals who are recently HIV-infected and individuals who have long-term infections. In this study, we examine the relationship between new HIV seroconversions occurring among young black men who have sex with men and network proximity to recently or long-term HIV-infected individuals. A cohort of young black men who have sex with men (N = 618) was generated through respondent-driven sampling across 3 waves. A recent HIV infection was defined as either: (1) a confirmed seroconversion ≤9 months before interview date or (2) a laboratory confirmed acute infection; long-term HIV-infected individuals were defined as a diagnosis date ≥9 months before interview date. Respondent-driven sampling-weighted logistic regression was used to examine network proximity of HIV transmission events to HIV-infected individuals in the network. Within the cohort, 343 (55.5%) participants were identified as HIV seronegative at baseline. Of these, 33 (9.6%) seroconverted during the study period. The odds of seroconversion increased significantly with each additional recent HIV-infected individual in one's network [adjusted odds ratio = 12.96; 95% confidence interval: 5.69 to 29.50], but were not significantly altered by the number of long-term infected individuals in one's network. In addition, for each member of one's network who used pre-exposure prophylaxis, the odds of seroconversion decreased significantly (adjusted odds ratio = 0.44; 95% confidence interval: 0.20 to 0.96). Early diagnosis and treatment is a critical first step in the HIV care continuum and together with pre-exposure prophylaxis awareness and use are critical targets for disrupting the transmission of HIV through most at-risk networks.

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The Impact of Insurance on HIV Testing

Cited by 15 publications

References 32 publications

HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011–2017 National Survey of Family Growth

HIV testing among pregnant women with prenatal care in the United States: An analysis of the 2011–2017 National Survey of Family Growth

Predictors of Health Insurance Enrollment among HIV Positive Pregnant Women in Kenya: Potential for Adverse Selection and Implications for HIV Treatment and Prevention

Are HIV Seroconversions Among Young Men Who Have Sex With Men Associated With Social Network Proximity to Recently or Long-Term HIV-Infected Individuals?

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