Smith Dawn K, Van Handel Michelle, Huggins Rebecca
*Division of HIV/AIDS Prevention (DHAP), National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA; and †Program and Performance Improvement Office, National Center for HIV, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), Centers for Disease Control and Prevention (CDC), Atlanta, GA.
J Acquir Immune Defic Syndr. 2017 Dec 15;76(5):465-472. doi: 10.1097/QAI.0000000000001532.
An estimated 1.2 million American adults engage in sexual and drug use behaviors that place them at significant risk of acquiring HIV infection. Engagement in health care for the provision of daily oral antiretroviral medication as preexposure prophylaxis (PrEP), when clinically indicated, could substantially reduce the number of new HIV infections in these persons. However, resources to cover the financial cost of PrEP care are anticipated barriers for many of the populations with high numbers of new HIV infections.
Using nationally representative data, we estimated the current national met and unmet need for financial assistance with covering the cost of PrEP medication, clinical visits, and laboratory tests among adults with indications for its use, overall and by transmission risk population.
This study found that of the 1.2 million adults estimated to have indications for PrEP use, <1% (∼7300) are in need of financial assistance for both PrEP medication and clinical care, at an estimated annual cost of $89 million. An additional 7% (∼86,300) are in need of financial assistance only for PrEP clinical care at an estimated annual cost of $119 million.
This information on PrEP care costs, insurance coverage, and unmet financial need among persons in key HIV transmission risk subpopulations can inform policy makers at all levels as they consider how to address remaining financial barriers to the use of PrEP and accommodate any changes in eligibility for various insurance and financial assistance programs that may occur in coming years.
据估计，120万美国成年人的性和吸毒行为使他们面临感染艾滋病毒的重大风险。在临床指征明确时，参与医疗保健以提供每日口服抗逆转录病毒药物作为暴露前预防（PrEP），可大幅减少这些人群中新发艾滋病毒感染的数量。然而，对于许多新发艾滋病毒感染人数众多的人群而言，支付PrEP治疗费用的资源预计将成为障碍。
利用具有全国代表性的数据，我们估计了目前全国范围内对有PrEP使用指征的成年人在支付PrEP药物、临床就诊和实验室检查费用方面已满足和未满足的经济援助需求，总体情况以及按传播风险人群划分的情况。
本研究发现，在估计有PrEP使用指征的120万成年人中，<1%（约7300人）在PrEP药物和临床护理方面都需要经济援助，估计每年费用为8900万美元。另外7%（约86300人）仅在PrEP临床护理方面需要经济援助，估计每年费用为1.19亿美元。
关于关键艾滋病毒传播风险亚人群中PrEP治疗费用、保险覆盖范围和未满足的经济需求的这些信息，可为各级政策制定者提供参考，帮助他们考虑如何消除使用PrEP的剩余经济障碍，并适应未来几年可能出现的各种保险和经济援助计划资格的任何变化。
