Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape
Introduction: Implementing HIV pre-exposure prophylaxis in the U.S. is critical to decreasing HIV transmission. However, regional disparities in pre-exposure prophylaxis use exist, with the southern U.S. having the lowest uptake relative to need. Community-based organizations in the South provide pr...
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Elsevier
2025-04-01
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| Series: | AJPM Focus |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2773065424001299 |
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| author | Connor Eichenwald, MD, MPH Robin T. Higashi, PhD Timothy P. Hogan, PhD Jacqueline Naeem, MD Julia L. Marcus, PhD, MPH Douglas Krakower, MD Ank E. Nijhawan, MD, MPH, MSCS |
| author_facet | Connor Eichenwald, MD, MPH Robin T. Higashi, PhD Timothy P. Hogan, PhD Jacqueline Naeem, MD Julia L. Marcus, PhD, MPH Douglas Krakower, MD Ank E. Nijhawan, MD, MPH, MSCS |
| author_sort | Connor Eichenwald, MD, MPH |
| collection | DOAJ |
| description | Introduction: Implementing HIV pre-exposure prophylaxis in the U.S. is critical to decreasing HIV transmission. However, regional disparities in pre-exposure prophylaxis use exist, with the southern U.S. having the lowest uptake relative to need. Community-based organizations in the South provide pre-exposure prophylaxis to many consumers, including those without health insurance. Methods: The authors convened a community-building pre-exposure prophylaxis summit in April 2023 with representatives from diverse pre-exposure prophylaxis providers, including community-based organizations in Dallas, Texas, to evaluate the impact of recent changes in pre-exposure prophylaxis funding mechanisms on their capabilities to provide pre-exposure prophylaxis. Participants completed surveys (n=17) and focus groups (n=14 individuals in 2 groups). Results: The authors found that reduced reimbursements from pre-exposure prophylaxis manufacturers have significantly altered the financial health of community-based organizations in Dallas, Texas, and jeopardized their capacity to provide pre-exposure prophylaxis. Community-based organizations reported difficulty in sustainably providing pre-exposure prophylaxis to uninsured clients because of fewer funds to cover unreimbursed costs for pre-exposure prophylaxis care. Many community-based organizations have diverted resources away from client outreach for pre-exposure prophylaxis and toward helping clients to enroll in commercial insurance plans that cover pre-exposure prophylaxis. These changes have further stressed community-based organizations by increasing the time spent by staff on managing prior authorizations for pre-exposure prophylaxis. Despite finding some success with workarounds, community-based organizations described continued financial fragility. Conclusions: These findings suggest that fragmented funding streams jeopardize the ability of these vital organizations to continue providing pre-exposure prophylaxis services in a jurisdiction with high HIV incidence. Potential solutions include enhanced collaboration across community-based organizations and stable financial support from a national pre-exposure prophylaxis program. |
| format | Article |
| id | doaj-art-9b27eee2c1ac4c79a4e42bf2f2abd6dc |
| institution | OA Journals |
| issn | 2773-0654 |
| language | English |
| publishDate | 2025-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | AJPM Focus |
| spelling | doaj-art-9b27eee2c1ac4c79a4e42bf2f2abd6dc2025-08-20T02:14:56ZengElsevierAJPM Focus2773-06542025-04-014210031110.1016/j.focus.2024.100311Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance LandscapeConnor Eichenwald, MD, MPH0Robin T. Higashi, PhD1Timothy P. Hogan, PhD2Jacqueline Naeem, MD3Julia L. Marcus, PhD, MPH4Douglas Krakower, MD5Ank E. Nijhawan, MD, MPH, MSCS6University of Texas Southwestern Medical School, Dallas, Texas; Address correspondence to: Connor Eichenwald, MD, University of Texas Southwestern Medical School, 5323 Harry Hines Boulevard, Dallas TX 75390.Peter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, TexasPeter O'Donnell School of Public Health, UT Southwestern Medical Center, Dallas, Texas; Center for Healthcare Organization & Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MassachusettsParkland Center for Clinical Innovation, Dallas, TexasDepartment of Population Medicine, Harvard Medical School, Boston, MassachusettsDepartment of Population Medicine, Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MassachusettsDivision of Infectious Diseases and Geographic Medicine, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TexasIntroduction: Implementing HIV pre-exposure prophylaxis in the U.S. is critical to decreasing HIV transmission. However, regional disparities in pre-exposure prophylaxis use exist, with the southern U.S. having the lowest uptake relative to need. Community-based organizations in the South provide pre-exposure prophylaxis to many consumers, including those without health insurance. Methods: The authors convened a community-building pre-exposure prophylaxis summit in April 2023 with representatives from diverse pre-exposure prophylaxis providers, including community-based organizations in Dallas, Texas, to evaluate the impact of recent changes in pre-exposure prophylaxis funding mechanisms on their capabilities to provide pre-exposure prophylaxis. Participants completed surveys (n=17) and focus groups (n=14 individuals in 2 groups). Results: The authors found that reduced reimbursements from pre-exposure prophylaxis manufacturers have significantly altered the financial health of community-based organizations in Dallas, Texas, and jeopardized their capacity to provide pre-exposure prophylaxis. Community-based organizations reported difficulty in sustainably providing pre-exposure prophylaxis to uninsured clients because of fewer funds to cover unreimbursed costs for pre-exposure prophylaxis care. Many community-based organizations have diverted resources away from client outreach for pre-exposure prophylaxis and toward helping clients to enroll in commercial insurance plans that cover pre-exposure prophylaxis. These changes have further stressed community-based organizations by increasing the time spent by staff on managing prior authorizations for pre-exposure prophylaxis. Despite finding some success with workarounds, community-based organizations described continued financial fragility. Conclusions: These findings suggest that fragmented funding streams jeopardize the ability of these vital organizations to continue providing pre-exposure prophylaxis services in a jurisdiction with high HIV incidence. Potential solutions include enhanced collaboration across community-based organizations and stable financial support from a national pre-exposure prophylaxis program.http://www.sciencedirect.com/science/article/pii/S2773065424001299HIV PreventionPrEP340B Programpharmaceutical pricingcommunity-based health organizations |
| spellingShingle | Connor Eichenwald, MD, MPH Robin T. Higashi, PhD Timothy P. Hogan, PhD Jacqueline Naeem, MD Julia L. Marcus, PhD, MPH Douglas Krakower, MD Ank E. Nijhawan, MD, MPH, MSCS Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape AJPM Focus HIV Prevention PrEP 340B Program pharmaceutical pricing community-based health organizations |
| title | Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape |
| title_full | Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape |
| title_fullStr | Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape |
| title_full_unstemmed | Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape |
| title_short | Supporting Access to HIV Pre-Exposure Prophylaxis in a Shifting Financial and Insurance Landscape |
| title_sort | supporting access to hiv pre exposure prophylaxis in a shifting financial and insurance landscape |
| topic | HIV Prevention PrEP 340B Program pharmaceutical pricing community-based health organizations |
| url | http://www.sciencedirect.com/science/article/pii/S2773065424001299 |
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