Increased HIV Transmissions With Reduced Insurance Coverage for HIV Preexposure Prophylaxis: Potential Consequences of<i>Braidwood Management v. Becerra</i>

Paltiel, A. David; Ahmed, Ali R.; Jin, Elena Y; McNamara, Meredithe; Freedberg, Kenneth A.; Neilan, Anne M.; Gonsalves, Gregg

doi:10.1093/ofid/ofad139

Cited by 3 publications

(1 citation statement)

References 11 publications

(11 reference statements)

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“…Importantly, socio-economic deprivation resulting from stigma and discrimination also impedes people's access to the resources needed to support their wellbeing, particularly among trans people experiencing multiple intersecting forms of oppression [75,76]. For example, anti-trans stigma has been shown to disrupt people's educational trajectories and adversely affect educational attainment in adulthood, subsequently limiting access to employment opportunities and stable housing, which in turn perpetuates high rates of poverty and financial precarity relative to cisgender people [30,70,[77][78][79][80][81][82][83][84][85][86]. This precarity may also lead to participation in sex work-thus conveying increased vulnerability to HIV transmission if engaging in condomless sex with clients and increased risk of surveillance, profiling, carceral system involvement due to the widespread criminalization of sex work [84,87].…”

Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

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IntroductionCurrent implementation efforts have failed to achieve equitable HIV pre‐exposure prophylaxis (PrEP) provision for transgender and gender‐diverse (trans) populations. We conducted a choice‐based conjoint analysis to measure preferences for key attributes of hypothetical PrEP delivery programmes among a diverse online sample predominantly comprised of transmasculine and nonbinary individuals in the United States.MethodsBetween April 2022 and June 2022, a national online survey with an embedded conjoint analysis experiment was conducted among 304 trans individuals aged ≥18 years in the United States to assess five PrEP programme attributes: out‐of‐pocket cost; dispensing venue; frequency of visits for PrEP‐related care; travel time to PrEP provider; and ability to bundle PrEP‐related care with gender‐affirming hormone therapy services. Participants responded to five questions, each of which presented two PrEP programme scenarios and one opt‐out option per question and selected their preferred programme in each question. We used hierarchical Bayes estimation and multinomial logistic regression to measure part‐worth utility scores for the total sample and by respondents’ PrEP status.ResultsThe median age was 24 years (range 18–56); 75% were assigned female sex at birth; 54% identified as transmasculine; 32% as nonbinary; 14% as transfeminine. Out‐of‐pocket cost had the highest attribute importance score (44.3%), followed by the ability to bundle with gender‐affirming hormone therapy services (18.7%). Minimal cost‐sharing ($0 out‐of‐pocket cost) most positively influenced the attribute importance of cost (average conjoint part‐worth utility coefficient of 2.5 [95% CI 2.4−2.6]). PrEP‐experienced respondents preferred PrEP delivery in primary care settings (relative utility score 4.7); however, PrEP‐naïve respondents preferred pharmacies (relative utility score 5.1).ConclusionsParticipants preferred programmes that offered PrEP services without cost‐sharing and bundled with gender‐affirming hormone therapy services. Bolstering federal regulations to cover PrEP services and prioritizing programmes to expand low‐barrier PrEP provision are critical to achieving equitable PrEP provision. Community‐engaged implementation research conducted by and in close collaboration with trans community stakeholders and researchers are needed to streamline the design of patient‐centred PrEP programmes and develop implementation strategies that are salient to the diverse sexual health needs of trans patients.

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Section: Discussionmentioning

confidence: 99%

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Watson,

Listerud,

Drab

et al. 2024

J Int AIDS Soc.

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Mental Health, Climate Change, and Bodily Autonomy

McNamara,

Barondeau,

Brown

2024

Pediatric Clinics of North America

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Projecting the Potential Clinical and Economic Impact of Human Immunodeficiency Virus Prevention Resource Reallocation in Tennessee

Borre,

Ahonkhai,

Chi

et al. 2024

Clinical Infectious Diseases

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Background In 2023, Tennessee replaced $6.2 M in US Centers for Disease Control and Prevention (CDC) human immunodeficiency virus (HIV) prevention funding with state funds to redirect support away from men who have sex with men (MSM), transgender women (TGW), and heterosexual Black women (HSBW) and to prioritize instead first responders (FR), pregnant people (PP), and survivors of sex trafficking (SST). Methods We used a simulation model of HIV disease to compare the clinical impact of Current, the present allocation of condoms, preexposure prophylaxis (PrEP), and HIV testing to CDC priority risk groups (MSM/TGW/HSBW); with Reallocation, funding instead increased HIV testing and linkage of Tennessee-determined priority populations (FR/PP/SST). Key model inputs included baseline condom use (45%–49%), PrEP provision (0.1%–8%), HIV testing frequency (every 2.5–4.8 years), and 30-day HIV care linkage (57%–65%). We assumed Reallocation would reduce condom use (−4%), PrEP provision (−26%), and HIV testing (−47%) in MSM/TGW/HSBW, whereas it would increase HIV testing among FR (+47%) and HIV care linkage (to 100%/90%) among PP/SST. Results Reallocation would lead to 166 additional HIV transmissions, 190 additional deaths, and 843 life-years lost over 10 years. HIV testing reductions were most influential in sensitivity analysis; even a 24% reduction would result in 287 more deaths compared to Current. With pessimistic assumptions, we projected 1359 additional HIV transmissions, 712 additional deaths, and 2778 life-years lost over 10 years. Conclusions Redirecting HIV prevention funding in Tennessee would greatly harm CDC priority populations while conferring minimal benefits to new priority populations.

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Increased HIV Transmissions With Reduced Insurance Coverage for HIV Preexposure Prophylaxis: Potential Consequences ofBraidwood Management v. Becerra

Cited by 3 publications

References 11 publications

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

HIV pre‐exposure prophylaxis programme preferences among sexually active HIV‐negative transgender and gender diverse adults in the United States: a conjoint analysis

Mental Health, Climate Change, and Bodily Autonomy

Projecting the Potential Clinical and Economic Impact of Human Immunodeficiency Virus Prevention Resource Reallocation in Tennessee

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