Financial Policy Issues for HIV Pre-Exposure Prophylaxis

Horberg, Michael A.; Raymond, Brian

doi:10.1016/j.amepre.2012.09.039

Cited by 37 publications

(34 citation statements)

References 7 publications

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“…This creates a significant barrier for many of those who would benefit from taking PrEP, despite research showing PrEP would save money that would otherwise be spent on HIV care when delivered to key populations at highest risk of HIV exposure (Gomez, et al, 2013). The Affordable Care Act, which has greatly expanded access to insurance coverage for many uninsured Americans, will provide a potential platform for PrEP benefit coverage (Horberg & Raymond, 2013). In addition, Gilead Sciences, the manufacturer of Truvada, has demonstrated a willingness to consider offering PrEP to low-income individuals at reduced or no cost (Gilead Sciences, 2011).…”

Section: Introductionmentioning

confidence: 99%

Attitudes and Perceptions of Biomedical HIV Prevention Methods: Voices from Young Men Who Have Sex with Men

2015

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In the third decade of the HIV/AIDS epidemic in the United States, the prevalence rates of new HIV infections among young men who have sex with men (YMSM) continue to increase. As new and emerging HIV prevention method are developed, it is important to understand the perceptions of this vulnerable population –as they may be an ideal target for these intervention methods. This pilot study provides an overview of YMSM of color’s awareness and perceptions of pre-exposure prophylaxis (PrEP) and rectal microbicides (RM). A total of 6 focus groups were convened with 53 YMSM (23 Latino/Hispanic and 30 Black/African American). Findings indicate a lack of knowledge of biomedical interventions and high perceived acceptability. Concerns regarding PrEP included potential side effects, potential for misinterpretation of its use and cost. RMs were perceived to be more acceptable than PrEP, but the limited knowledge about their potential was emphasized by YMSM. Results are discussed in relation to the need for providers to continue to provide general health education about safe sexual practices. As PrEP and other biomedical interventions are introduced into community settings, caution should be taken with regards to determining the appropriate target user and sufficient education.

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Section: Introductionmentioning

confidence: 99%

Attitudes and Perceptions of Biomedical HIV Prevention Methods: Voices from Young Men Who Have Sex with Men

2015

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“…Several prior studies, however, have documented above-average proportions of uninsured individuals among populations at elevated risk for HIV infection, including men who have sex with men [25], [26]. The full cost of tenofovir with emtricitabine (TDF-FTC) for PrEP in the US is approximately $17,000 per year for the medication alone [27]; the total costs of PrEP per individual per year including laboratory services and professional fees approach approximately $18,000 (not including any treatment for side effects). Even among insured individuals, coverage for PrEP may be incomplete, and cost-sharing requirements such as co-pays or co-insurance may limit access [27], [28].…”

Section: Introductionmentioning

confidence: 99%

“…The full cost of tenofovir with emtricitabine (TDF-FTC) for PrEP in the US is approximately $17,000 per year for the medication alone [27]; the total costs of PrEP per individual per year including laboratory services and professional fees approach approximately $18,000 (not including any treatment for side effects). Even among insured individuals, coverage for PrEP may be incomplete, and cost-sharing requirements such as co-pays or co-insurance may limit access [27], [28]. Although the manufacturer of TDF-FTC has instituted a medication assistance program, the effect of this program on access to PrEP is still under study [27].…”

Section: Introductionmentioning

confidence: 99%

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Access to Healthcare, HIV/STI Testing, and Preferred Pre-Exposure Prophylaxis Providers among Men Who Have Sex with Men and Men Who Engage in Street-Based Sex Work in the US

et al. 2014

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BackgroundPre-exposure prophylaxis (PrEP) is a promising strategy for HIV prevention among men who have sex with men (MSM) and men who engage in sex work. But access will require routine HIV testing and contacts with healthcare providers. This study investigated men’s healthcare and HIV testing experiences to inform PrEP implementation.MethodsWe conducted 8 focus groups (n = 38) in 2012 and 56 in-depth qualitative interviews in 2013–14 with male sex workers (MSWs) (n = 31) and other MSM (n = 25) in Providence, RI. MSWs primarily met clients in street-based sex work venues. Facilitators asked participants about access to healthcare and HIV/STI testing, healthcare needs, and preferred PrEP providers.ResultsMSWs primarily accessed care in emergency rooms (ERs), substance use clinics, correctional institutions, and walk-in clinics. Rates of HIV testing were high, but MSWs reported low access to other STI testing, low insurance coverage, and unmet healthcare needs including primary care, substance use treatment, and mental health services. MSM not engaging in sex work were more likely to report access to primary and specialist care. Rates of HIV testing among these MSM were slightly lower, but they reported more STI testing, more insurance coverage, and fewer unmet needs. Preferred PrEP providers for both groups included primary care physicians, infectious disease specialists, and psychiatrists. MSWs were also willing to access PrEP in substance use treatment and ER settings.ConclusionsPrEP outreach efforts for MSWs and other MSM should engage diverse providers in many settings, including mental health and substance use treatment, ERs, needle exchanges, correctional institutions, and HIV testing centers. Access to PrEP will require financial assistance, but can build on existing healthcare contacts for both populations.

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“…An analysis of pharmacy claims found that between January 2012 and September 2013, only 2319 people filled prescriptions for FTC/TDF PrEP in the US and almost half were women 16 . Several factors, including perceived low demand for PrEP 17-19 , inadequate access to insurance or healthcare 20 , lack of provider knowledge or willingness to prescribe PrEP 21-24 , and concerns about adherence 25 , HIV resistance 26 , risk compensation 27 , and cost 20,28 may explain why there has not been rapid dissemination of this innovation. Demonstration projects have been recommended to address implementation issues and help determine if appropriate and how best to scale-up PrEP 29,30 .…”

mentioning

confidence: 99%

High Interest in Preexposure Prophylaxis Among Men Who Have Sex With Men at Risk for HIV Infection

Cohen

Vittinghoff

Bacon

et al. 2015

JAIDS Journal of Acquired Immune Deficiency Syndromes

175

134

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Background Pre-exposure prophylaxis (PrEP) is the first biomedical intervention with proven efficacy to reduce human immunodeficiency virus (HIV) acquisition in men who have sex with men (MSM) and transgender women (TGW). Little is known about levels of interest and characteristics of individuals who elect to take PrEP in real-world clinical settings. Methods The US PrEP Demonstration Project is a prospective, open-label cohort study assessing PrEP delivery in municipal STD clinics in San Francisco and Miami and a community health center in Washington, DC. HIV-uninfected MSM and TGW seeking sexual health services at participating clinics were assessed for eligibility and offered up to 48 weeks of emtricitabine/tenofovir for PrEP. Predictors of enrollment were assessed using a multivariable Poisson regression model, and characteristics of enrolled participants are described. Results Of 1069 clients assessed for participation, 921 were potentially eligible and 557 (60.5%) enrolled. In multivariable analysis, participants from Miami (aRR 1.53; 95% CI 1.33-1.75) or DC (aRR 1.33; 95% CI 1.2-1.47), those who were self-referred (aRR 1.48; 95% CI 1.32-1.66), with prior PrEP awareness (aRR 1.56; 95% CI 1.05-2.33) and those reporting >1 episode of anal sex with an HIV-infected partner in the last 12 months (aRR 1.20; 95% CI 1.09-1.33) were more likely to enroll. Almost all (98%) of enrolled participants were MSM, and at baseline, 63.5% reported condomless receptive anal sex in the prior three months. Conclusions Interest in PrEP is high among a diverse population of MSM at risk for HIV infection when offered in STD and community health clinics.

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Financial Policy Issues for HIV Pre-Exposure Prophylaxis

Cited by 37 publications

References 7 publications

Attitudes and Perceptions of Biomedical HIV Prevention Methods: Voices from Young Men Who Have Sex with Men

Attitudes and Perceptions of Biomedical HIV Prevention Methods: Voices from Young Men Who Have Sex with Men

Access to Healthcare, HIV/STI Testing, and Preferred Pre-Exposure Prophylaxis Providers among Men Who Have Sex with Men and Men Who Engage in Street-Based Sex Work in the US

High Interest in Preexposure Prophylaxis Among Men Who Have Sex With Men at Risk for HIV Infection

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