Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention.

Rupa R Patel,Timothy Mcbride,Philip A Chan,Catherine E Oldenburg,Jingxia Liu,Amy Nunn,Kenneth H Mayer,Leandro Mena,Laura C Harrison,Anne S De Groot

doi:10.1371/journal.pone.0178737

Abstract

Pre-exposure prophylaxis (PrEP) can reduce U.S. HIV incidence. We assessed insurance coverage and its association with PrEP utilization. We reviewed patient data at three PrEP clinics (Jackson, Mississippi; St. Louis, Missouri; Providence, Rhode Island) from 2014–2015. The outcome, PrEP utilization, was defined as patient PrEP use at three months. Multivariable logistic regression was performed to determine the association between insurance coverage and PrEP utilization. Of 201 patients (Jackson: 34%; St. Louis: 28%; Providence: 28%), 91% were male, 51% were White, median age was 29 years, and 21% were uninsured; 82% of patients reported taking PrEP at three months. Insurance coverage was significantly associated with PrEP utilization. After adjusting for Medicaid-expansion and individual socio-demographics, insured patients were four times as likely to use PrEP services compared to the uninsured (OR: 4.49, 95% CI: 1.68–12.01; p = 0.003). Disparities in insurance coverage are important considerations in implementation programs and may impede PrEP utilization.

Highlights

In 2014, over 40,000 individuals were diagnosed with human immunodeficiency virus (HIV) infection in the United States (US) with the majority among men who have sex with men (MSM) [1]
Insurance remained significant when adjusting for state Medicaid expansion (Model 2) as well as for study site (Model 3) (OR = 4.49, 95% CI: 1.68–12.01 and odds ratio (OR) = 3.98, 95% CI: 1.36–11.63, respectively)
We found that having insurance coverage may significantly impact Pre-exposure prophylaxis (PrEP) utilization

Summary

Introduction

In 2014, over 40,000 individuals were diagnosed with human immunodeficiency virus (HIV) infection in the United States (US) with the majority among men who have sex with men (MSM) [1]. There are large disparities in HIV incidence, with African Americans facing a disproportionate burden of new infections [1]. Pre-exposure prophylaxis (PrEP) refers to the use of antiretrovirals to prevent HIV infection prior to exposure. It is estimated that over 1.2 million. KL2TR000450, from the National Center for Advancing Translational Sciences of the National Institutes of Health, and the Washington University in St. Louis Institute for Public Health Cubed Funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript

Methods

Results

Conclusion