The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals

Adamson, Blythe; Lipira, Lauren; Katz, Aaron

doi:10.1007/s11904-019-00429-6

Cited by 8 publications

(11 citation statements)

References 26 publications

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“…The U.S. Department of Health and Human Services has prioritized efforts to lower prescription drug prices and reduce out-of-pocket costs † . Medicaid expansion has reduced the number of persons with HIV infection who are uninsured and is associated with an increase in the number of persons who are taking ART and are virally suppressed ( 7 ). CDC has provided information for state and local HIV prevention and care programs regarding Medicaid coverage for persons with HIV infection to improve access to care and medications ( 8 ).…”

Section: Discussionmentioning

confidence: 99%

Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017

Beer

Tie

Weiser

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

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Section: Discussionmentioning

confidence: 99%

Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017

Beer

Tie

Weiser

et al. 2019

MMWR Morb. Mortal. Wkly. Rep.

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“…The Medicaid Expansion scenario was modeled by assuming a 5% increase in HIV testing rates, in accordance with recent data, 19 a 2% increase in the proportion of HIV-negative persons using PrEP, 20 , 36 and a 17% improvement in ART adherence. 19 , 37 Using this scheme, three Medicaid expansion policy scenarios were simulated: (a) Medicaid Expansion (ME1), as described above (Tables 1 , 2 ); (b) ME1 plus a 20% increase in PrEP uptake (ME2); and (c) ME1 plus a 30% increase in PrEP uptake and a 15% increase in ART uptake (ME3). The ART and PrEP uptake expansion rates in scenarios (b) and (c) were selected based on the study team’s results on achieving HIV elimination targets when applying this model to a YBMSM population in another large US city.…”

Section: Methodsmentioning

confidence: 99%

“…[14][15][16][17][18] Medicaid expansion has been shown to improve engagement in both the antiretroviral treatment (ART) and PrEP continua. [19][20][21] A number of empirical and simulation studies have projected declines in downstream HIV incidence because of improved ART and PrEP continuum engagement. 22 However, little is known about how Medicaid expansion is likely to impact downstream HIV incidence, particularly in Houston, which remains among the urban epicenters of HIV in the Southern United States.…”

mentioning

confidence: 99%

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Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas

et al. 2022

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Context: Medicaid expansion has been nationally shown to improve engagement in the human immunodeficiency virus (HIV) treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the United States are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern United States with a racially/ethnically diverse population that is located in 1 of 11 US states that have not yet expanded Medicaid coverage as of 2021. Methods: An agent-based model that incorporated the sexual networks of YBMSM was used to simulate improved antiretroviral treatment and pre-exposure prophylaxis (PrEP) engagement through Medicaid expansion in Houston, TX. Analyses considered the HIV incidence (number of new infections and as a rate metric) among YBMSM over the next 10 years under Medicaid expansion as the primary outcome. Additional scenarios, involving viral suppression and PrEP uptake above the projected levels achieved under Medicaid expansion, were also simulated. Results: The baseline model projected an HIV incidence rate of 4.96 per 100 person years (py) and about 368 new annual HIV infections in the 10th year. Improved HIV treatment and prevention continua engagement under Medicaid expansion resulted in a 14.9% decline in the number of annual new HIV infections in the 10th year. Increasing viral suppression by an additional 15% and PrEP uptake by 30% resulted in a 44.0% decline in new HIV infections in the 10th year, and a 27.1% decline in cumulative infections across the 10 years of the simulated intervention. Findings: Simulation results indicate that Medicaid expansion has the potential to reduce HIV incidence among YBMSM in Houston. Achieving HIV elimination objectives, however, might require additional effective measures to increase antiretroviral treatment and PrEP uptake beyond the projected improvements under expanded Medicaid.

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“…Furthermore, the ACA expanded the Medicaid programme in participating states to include adults with incomes of less than 138% of the federal poverty amount, and supported innovations to improve efficiency and effectiveness of medical care delivery. 10 Failure of most southern states to participate in the ACA might have increased adverse outcomes for vulnerable people with HIV. 11 Higher risks for people living in the west were unexpected; no data on people with HIV in the midwest USA were included.…”

mentioning

confidence: 99%

Use of big data to identify risk of adverse HIV outcomes

Vermund

2019

The Lancet HIV

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Goals were set in 2014-15 by the UN Programme on HIV/AIDS and WHO to accelerate global HIV prevention and to reduce morbidity and mortality by 2020. The 90-90-90 goals seek to motivate improving the continuum of care with at least 90% of all people with HIV knowing their HIV status, 90% of those people taking antiretroviral therapy (ART), and 90% of people on ART achieving virological suppression. Early treatment reduces both adverse outcomes and infectiousness to others; therefore, there are compelling clinical and public health reasons to maximize 90-90-90 coverage at a community and population scale. The USA, home of the world's largest economy, lags in 90-90-90 achievement compared with other high-income nations and even middle-income countries, such as Botswana.

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The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals

Cited by 8 publications

References 26 publications

Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017

Nonadherence to Any Prescribed Medication Due to Costs Among Adults with HIV Infection — United States, 2016–2017

Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas

Use of big data to identify risk of adverse HIV outcomes

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