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

Year: 2022
Type: article
Abstract: 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.
Source: Medical Care
DOI: 10.1097/mlr.0000000000001772
Authors: Francis Lee, Aditya S. Khanna, Camden J. Hallmark, Richa Lavingia, Marlene McNeese, Jing Zhao, Melanie L. McNeese, Salma Khuwaja, Babak M. Ardestani, Nicholson Collier, Jonathan Ozik, Anna L. Hotton, Nina T. Harawa, John A. Schneider, Kayo Fujimoto
Institutions: University of Chicago, Brown University, Houston Health and Human Services Department, Baylor College of Medicine, The University of Texas Health Science Center at Houston, Argonne National Laboratory, University of California System, Charles R. Drew University of Medicine and Science
Language: English
Field: Medicine
Open Access status: hybrid
Funders: U.S. Department of Health and Human Services, Brown University, National Institutes of Health, Centers for Disease Control and Prevention, Center for AIDS Research, University of Washington, National Institute of Mental Health, National Institute on Drug Abuse, National Institute of General Medical Sciences, National Institute of Allergy and Infectious Diseases
Awards: G1154016560, G1211841367, G1276500078, G1465858782, INTEGRATED HIV SURVEILLANCE AND PREVENTION PROGRAMS FOR HEALTH DEPARTMENTS - 2018, NATIONAL HIV BEHAVIORAL SURVEILLANCE (NHBS): CONDUCT BEHAVIORAL SURVEILLANCE AMONG PERSONS AT HIGH RISK FOR HIV INFECTION IN ROTATING ANNUAL CYCLES I, Next-Generation Phylodynamics-targeted Partner Service Models for Combined HIV Prevention, G5267713852, HIV intervention models for criminal justice involved substance-using Black MSM, G790771369, Using big data and deep learning on predicting HIV transmission risk in MSM population, G9000021443, G9000070327, Center for HIV Identification, Prevention and Treatment Services, Integrative Training in the Neurobiology of Addictive Behaviors
OpenAlex ID: W4311577189
FWCI: 0.565
Cites: 34
Cited by: 8
Related to: 10