How Insurance Disparities Affect PrEP Utilization

insured patients were 4 times more likely than uninsured patients to use PrEP services
insured patients were 4 times more likely than uninsured patients to use PrEP services

Insurance disparities may impede utilization of pre-exposure prophylaxis (PrEP) to prevent incidence of human immunodeficiency virus (HIV), according to a team of researchers headed by Rupa Patel, MD, MPH, of the Division of Infectious Diseases, Washington University in St. Louis.

The authors state that an estimated 1.2 million adults in the US are at risk for HIV and would benefit from PrEP, which is regarded as a “national priority to reduce new HIV infections”.

Previous research suggested that lack of adequate insurance coverage “may be a potential barrier” to PrEP use. To further assess the association of insurance coverage with PrEP utilization, the researchers reviewed data of patients at 3 PrEP clinics (n=201) in Jackson, Mississippi, St Louis, Missouri, and Providence, Rhode Island from 2014 to 2015. The outcome, PrEP utilization, was defined as patient PrEp use at 3 months. 

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Of the total number of patients, 91% were male, 52% were white, 21% were uninsured, and the median age of patients was 29 years. Only 82% reported taking PrEP at 3 months.

Insurance coverage was significantly associated with PrEP utilization, the researchers found. After adjusting for Medicaid-expansion and individual socio-demographics, they found that insured patients were 4 times more likely than uninsured patients to use PrEP services (OR: 4.49, 95% CI: 1.68-12.01; P=0.003).

“Disparities in insurance coverage are important considerations in implementation programs,” they concluded, adding that “state- and local-level PrEP implementation efforts should address barriers to insurance coverage as a critical component to successful programmatic efforts.”

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