University of Virginia, School of Medicine, Division of Infectious Diseases and International Health, Charlottesville, Virginia, USA.
NASTAD, Health Systems and Policy, Washington, District of Columbia, USA.
AIDS Res Hum Retroviruses. 2020 Oct;36(10):842-851. doi: 10.1089/AID.2020.0013. Epub 2020 Aug 12.
Insurance enrollment is complex for people living with HIV (PLWH) and people at increased risk for HIV, in part, owing to needing to ensure access to adequate provider networks and appropriate formularies. Insurance for PLWH facilitates access to HIV care/treatment and, ultimately, viral suppression, which has the individual benefit of longevity and the public health benefit of decreased HIV transmission. For people at increased risk for HIV, access to insurance facilitates improved access to HIV biomedical prevention, which has the individual benefit of elimination of transmission risk and the public health benefit of decreased HIV transmission. The objective of this study was to explore perceptions of priorities related to plan navigation, barriers and facilitators for enrolling and maintaining insurance coverage, and questions related to regional, state, and federal policies impacting plans provided both on and off the Affordable Care Act (ACA) marketplace. We interviewed a national sample of assisters ( = 40), who specialize in insurance plan selection for these populations. We found that assisters tailor their approaches to HIV-specific and person-specific concerns by navigating challenges related to affordability, formularies, and provider networks. In a complex coverage landscape during a time of uncertainty about the long-term future of the ACA, assisters have mastered the ability to simplify the insurance selection process for a vulnerable population. Assisters have excelled at incorporating insurance literacy education and encouraging client engagement in the process. Assisters play an essential role in the current complicated and fragmented United States' health care delivery system for PLWH and people at increased risk for HIV and could be incorporated into the Ending the HIV Epidemic initiative.
保险登记对于感染艾滋病毒的人（PLWH）和艾滋病毒感染风险较高的人来说比较复杂，部分原因是需要确保能够获得足够的医疗服务网络和适当的保险方案。PLWH 的保险有助于获得艾滋病毒护理/治疗，并最终实现病毒抑制，这对个人有长寿的好处，对公共卫生有减少艾滋病毒传播的好处。对于艾滋病毒感染风险较高的人来说，获得保险可以改善获得艾滋病毒生物医学预防的机会，这对个人有消除传播风险的好处，对公共卫生有减少艾滋病毒传播的好处。本研究的目的是探讨与计划导航相关的优先事项的看法，以及登记和维持保险覆盖的障碍和促进因素，以及与影响平价医疗法案（ACA）市场内外计划的区域、州和联邦政策相关的问题。我们采访了全国范围内的助手样本（ = 40），他们专门为这些人群选择保险计划。我们发现，助手通过解决与可负担性、保险方案和医疗服务网络相关的挑战，针对艾滋病毒的具体问题和个人的具体问题，调整他们的方法。在 ACA 长期未来不确定的复杂覆盖环境下，助手已经掌握了为弱势人群简化保险选择过程的能力。助手在纳入保险知识教育和鼓励客户参与这一过程方面表现出色。助手在美国当前复杂和分散的艾滋病毒感染者和艾滋病毒感染风险较高的人的医疗保健提供系统中发挥着至关重要的作用，并且可以被纳入终结艾滋病毒流行倡议。
