PUBLIC HEALTHFunding Cuts to U.S. HIV Preventive Services Could Lead to Thousands More Cases, Billions in Costs
Two just-published studies estimate the health and economic consequences of reducing, interrupting, or ceasing HIV preventive services in the United States, revealing thousands of new infections and costs in the billions over the next decade.
Two just-published studies estimate the health and economic consequences of reducing, interrupting, or ceasing HIV preventive services in the United States, revealing thousands of new infections and costs in the billions over the next decade, although the results of the second study show considerable uncertainty, with wide credible intervals in the estimates.
Increasing Out-of-Pocket Costs, Copayments
Led by Emory University researchers and published yesterday in JAMA Network Open, the first study explored the likely changes in HIV transmission and healthcare costs if policy changes result in decreased HIV pre-exposure prophylaxis (PrEP) use in the United States.
The team used population-based data, PrEP prescription information from 2012 to 2022, estimates from a previously published clinical model, and parameters from a previously published ecological model to describe population-level PrEP use and new diagnoses under different hypothetical changes in PrEP coverage sparked by federal policy changes.
Scenario 1 was based on an assumption that the increases in PrEP coverage observed during the past decade would be reversed over the following decade. The other two scenarios took the same approach but at alternative levels of 10% (scenario 2) and 2% (scenario 3) absolute annual decreases.
Discounted analyses indicate the present value, reflecting the time value of money, while undiscounted analyses represent the total projected cash flows linked to the scenario.
Earlier this year, amid sizable cuts to US Health and Human Services public health staff and programs, reducing public funding for PrEP programs through approaches such as increasing out-of-pocket costs and copayments was discussed.
“PrEP, when taken as directed, reduces the risk of acquiring HIV by as much as 99%,” the investigators wrote. “Critically, changes in policies that lead to increased out-of-pocket PrEP costs or that decrease access to proximate PrEP locations could reduce PrEP coverage, resulting in excess HIV infections and costs.”
8,600 Excess HIV Infections, $3.6 Billion in Costs
The authors noted that PrEP use is four times more likely among patients with health insurance and that equitable PrEP use is substantially higher in states with Medicaid expansion or PrEP drug–assistance programs and highest in states with both.
In 2012, of 9,565 US PrEP users, 61.2% were male, 74.3% were aged 25 to 54 years, 56.5% were White, 19.4% were Black, and 12.9% were Hispanic.
