Impact Of Medicaid Expansion On HIV Pre-Exposure Prophylaxis Coverage, 2012-23

Area of Science:

• Public Health
• Epidemiology
• Health Policy

Background:

• Pre-exposure prophylaxis (PrEP) is crucial for HIV prevention but remains underutilized in the US.
• Understanding factors influencing PrEP uptake is essential for effective HIV prevention strategies.

Purpose of the Study:

• To evaluate the impact of Medicaid expansion on state-level PrEP prescribing outcomes.
• To assess how Medicaid expansion influences the ratio of PrEP prescriptions to new HIV diagnoses.

Main Methods:

• Utilized HIV surveillance data from all 50 states and Washington, D.C. (2012-2023).
• Employed a staggered difference-in-differences approach to analyze the effects of Medicaid expansion.
• Examined PrEP coverage and the PrEP-to-need ratio as key outcome measures.

Main Results:

• PrEP coverage increased over time but showed no statistically significant association with Medicaid expansion.
• Medicaid expansion was significantly associated with increased PrEP-to-need ratios, indicating improved access relative to new HIV diagnoses.
• The positive effect of Medicaid expansion on the PrEP-to-need ratio strengthened over time and was consistent across subgroups.

Conclusions:

• Medicaid expansion effectively improved PrEP access in relation to HIV diagnoses.
• Despite overall improvements, differential impacts by race and ethnicity suggest potential widening disparities in PrEP access.
• Further research is needed to address racial and ethnic inequities in PrEP utilization.