Insurance coverage and financing landscape for HIV treatment and prevention in the USA

The Lancet Series on HIV in the USA describes the current state of the nation's HIV epidemic, including ongoing inequities and challenges for key populations and comorbidities. [1][2][3][4][5][6] Black Americans have consistently shouldered many of these HIV inequities, a pattern also seen in the COVID-19 pandemic. The overlapping racial disparities related to COVID-19 and HIV 7,8 highlight lessons that policy makers, public health practitioners, providers, and communities can leverage in their strategies to eliminate the Same script, different viruses: HIV and COVID-19 in US Black communities in subgroups of patients including SMuRF-less patients and women is mandatory.However, the success of risk stratification and treatment depends on accurate diagnosis and identification of the underlying disease mechanisms. Several different disease mechanisms have been identified in STEMI. Atherosclerotic coronary artery occlusion is the most common finding in patients with STEMI. 1 However, in myocardial infarction with non-obstructive coronary arteries, which is particularly common in women, several other disease mechanisms have been identified. These include non-obstructive coronary artery atherosclerosis and plaque rupture, coronary artery embo lism, vasospasm, and spontaneous coronary artery dissection (SCAD). 11,12 In female patients with SCAD, Figtree and colleagues observed a lower 30-day mortality rate than for female patients without SCAD; however, SCAD is particularly common among young and middle-aged women (≤50 years) and associated with underlying systemic arteriopathy with a recurrence rate of 10-30% and a reduction in quality of life. 12 A further consideration is that Takotsubo cardiomyopathy or stress cardiomyopathy might mimic STEMI. 13 Therefore, a detailed assessment is indicated in select patients with STEMI, supplementing invasive coronary angiography with cardiac MRI, to exclude myocarditis and detect myocardial necrosis, and an intravascular assessment of coronary flow and structure, possibly also including functional testing. Such a comprehensive assessment would secure correct diagnosis, risk assessment, and treatment, particularly in women with STEMI and nonobstructive coronary arteries.Without consideration of risk, there cannot be gain, and thus new sex-specific risk factors and risk markers should be implemented in clinical risk models that can identify high-risk individuals among SMuRF-less patients with STEMI. Improvement in risk stratification and accurate diagnosis would help to tailor treatment in SMuRF-less patients, reducing the excess mortality and avoiding undertreatment in this subgroup.I declare no competing interests.

show abstract

“…

…”

mentioning

confidence: 96%

Same script, different viruses: HIV and COVID-19 in US Black communities

2021

View full text Add to dashboard Cite

show abstract

“…HIV disproportionately affects persons of color, men who have sex with men, transgender women, those who inject drugs, and those with lower socioeconomic status 17 . Medicaid is the most important source of health insurance for PLWH, providing coverage for 40% of PLWH in 2018 18 . This large representation of PLWH in Medicaid underscores the importance of evaluating their health care needs, including their needs for cancer prevention and control.…”

Section: Introductionmentioning

confidence: 99%

“…17 Medicaid is the most important source of health insurance for PLWH, providing coverage for 40% of PLWH in 2018. 18 This large representation of PLWH in Medicaid underscores the importance of evaluating their health care needs, including their needs for cancer prevention and control.…”

Section: Introductionmentioning

confidence: 99%

Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data

Koroukian

Navale

Schiltz

et al. 2022

Cancer

View full text Add to dashboard Cite

BACKGROUND: Cancer is one of the most common comorbidities in men living with HIV (MLWH). However, little is known about the MLWH subgroups with the highest cancer burden to which cancer prevention efforts should be targeted. Because Medicaid is the most important source of insurance for MLWH, we evaluated the excess cancer prevalence in MLWH on Medicaid relative to their non-HIV counterparts. METHODS: In this cross-sectional study using 2012 Medicaid Analytic eXtract data nationwide, we flagged the presence of HIV, 13 types of cancer, symptomatic HIV, and viral coinfections using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. The study population included individuals administratively noted to be of male sex (men), aged 18 to 64 years, with (n = 82,495) or without (n = 7,302,523) HIV. We developed log-binomial models with cancer as the outcome stratified by symptomatic status, age, and race/ethnicity. RESULTS: Cancer prevalence was higher in MLWH than in men without HIV (adjusted prevalence ratio [

show abstract

“…Because US people with HIV (PWH) experience higher levels of these factors relative to the total population [4][5][6], PWH may have been substantially affected by the pandemic. However, employment and private health insurance coverage are lower among PWH compared with the total population and a large percentage rely on Medicaid or the Ryan White HIV/AIDS Program (RWHAP) [5,7], which provide access to essential services that can help meet subsistence and mental health needs [8]. Although some have found high unemployment and subsistence needs such as housing and food insecurity among PWH attributed to the pandemic [9,10], others have not found increased food insecurity [11]; these studies are also limited to certain geographic areas or populations.…”

Section: Introductionmentioning

confidence: 99%

The COVID-19 pandemic and unemployment, subsistence needs and mental health among adults with HIV in the United States

Beer

Tie²,

Dasgupta³

et al. 2021

Aids

View full text Add to dashboard Cite

Objective:To evaluate whether reported prevalence of unemployment, subsistence needs, and symptoms of depression and anxiety among adults with diagnosed HIV during the COVID-19 pandemic were higher than expected.Design:The Medical Monitoring Project (MMP) is a complex sample survey of adults with diagnosed HIV in the United States.Methods:We analyzed 2015–2019 MMP data using linear regression models to calculate expected prevalence, along with corresponding prediction intervals (PI), for unemployment, subsistence needs, depression, and anxiety for June–November 2020. We then assessed whether observed estimates fell within the expected prediction interval for each characteristic, overall and among specific groups.Results:Overall, the observed estimate for unemployment was higher than expected (17% vs. 12%) and exceeded the upper limit of the PI. Those living in households with incomes ≥400% of FPL were the only group where the observed prevalence of depression and anxiety during the COVID-19 period was higher than the PIs; in this group, the prevalence of depression was 9% compared with a predicted value of 5% (75% higher) and the prevalence of anxiety was 11% compared with a predicted value 5% (137% higher). We did not see elevated levels of subsistence needs, although needs were higher among Black and Hispanic compared with White persons.Conclusions:Efforts to deliver enhanced employment assistance to persons with HIV and provide screening and access to mental health services among higher income persons may be needed to mitigate the negative effects of the US COVID-19 pandemic.

show abstract

Insurance coverage and financing landscape for HIV treatment and prevention in the USA

Cited by 30 publications

References 7 publications

Same script, different viruses: HIV and COVID-19 in US Black communities

Same script, different viruses: HIV and COVID-19 in US Black communities

Excess cancer prevalence in men with HIV: A nationwide analysis of Medicaid data

The COVID-19 pandemic and unemployment, subsistence needs and mental health among adults with HIV in the United States

Contact Info

Product

Resources

About