《ACA 和医疗补助扩张对实现 UNAIDS 90-90-90 目标进展的影响》。
The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals.
机构信息
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, 1959 NE Pacific Street, HSB H-375, Box 357630, Seattle, WA, 98195-7630, USA.
Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, USA.
出版信息
Curr HIV/AIDS Rep. 2019 Feb;16(1):105-112. doi: 10.1007/s11904-019-00429-6.
PURPOSE OF REVIEW
Passage of the Affordable Care Act (ACA) in 2010 and subsequent Medicaid expansion has influenced access to HIV treatment and care in the USA. This review aims to evaluate whether the implementation of these policies has impacted progress toward UNAIDS 90-90-90 goals.
RECENT FINDINGS
Preliminary evidence has emerged suggesting that the ACA and Medicaid expansion has increased the likelihood of HIV testing and diagnosis, reduced the number of people unaware of HIV infection, and increased the number of people on antiretroviral therapy (ART) who are virally suppressed. While the ACA is associated with some progress toward 90-90-90 goals, more years of data after policy implementation are needed for robust analysis. Methods including difference-in-differences, instrumental variables, and propensity scores are recommended to minimize bias from unmeasured confounders and make causal inference about non-random Medicaid expansion among states.
综述目的：2010 年平价医疗法案（ACA）的通过和随后的医疗补助计划扩大，影响了美国获得艾滋病毒治疗和护理的机会。本综述旨在评估这些政策的实施是否对实现联合国艾滋病规划署 90-90-90 目标产生了影响。
最新发现：初步证据表明，ACA 和医疗补助计划的扩大增加了艾滋病毒检测和诊断的可能性，减少了不知道自己感染艾滋病毒的人数，并增加了接受抗逆转录病毒治疗（ART）且病毒得到抑制的人数。虽然 ACA 与实现 90-90-90 目标的某些进展相关，但在政策实施后还需要更多年的数据进行稳健分析。建议采用差异法、工具变量和倾向评分等方法，以最小化未测量混杂因素的偏差，并对各州之间非随机的医疗补助计划扩大做出因果推断。
Zotero 插件