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Original Articles Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas: Insights From a Modeling Study
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1 2023
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Source: Med Care. 61(1):12-19
[PDF-309.87 KB]
Details:
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Alternative Title:Med Care
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Personal Author:
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Description:Context:
Medicaid expansion has been nationally shown to improve engagement in the HIV treatment and prevention continua, which are vital steps to stopping the HIV epidemic. New HIV infections in the U.S. are disproportionately concentrated among young Black men who have sex with men (YBMSM). Houston, TX, is the most populous city in the Southern U.S. with a racially/ethnically diverse population that is located in one of eleven U.S. states that have not yet expanded Medicaid coverage as of 2021.
Methods:
An agent-based model that incorporated the sexual networks of YBMSM was employed to simulate improved ART and 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 tenth 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 tenth 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 tenth year, and a 27.1% decline in cumulative infections across the ten 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 ART and PrEP uptake beyond the projected improvements under expanded Medicaid.
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Pubmed ID:36477617
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Pubmed Central ID:PMC9733589
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Volume:61
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Issue:1
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