Publications

How Will Proposed Medi-Cal Cost Sharing Affect People Living With HIV in California?

California Gov. Brown proposed Medicaid co-payments that would impose significant financial barriers on the receipt of medical care by persons living with HIV (PLWH), who require substantial amounts of Medi-Cal care annually. This analysis quantifies those costs based on actual medical utilization experience of PLWH in California in prior years. PLWH average 10.3 outpatient visits a year. Copayments for these visits as well as for emergency room visits, medications, inpatient and dental care would impose cost-sharing on the average PLWH in California of over $312. PLWH who use the most services could face charges of up to $4760. If hard...

California’s HIV Surveillance System: Ensuring that it Fully Reflects Caseload

In order to develop a surveillance system for California that best serves public health needs and assures the state of obtaining its “fair share” of Ryan White funding, this policy brief recommends: 1) expanding outreach efforts; 2)erasing the distinct on between and HIV and AIDS status to redeploy resources used in reclassification; 3) assuring that all persons receiving RW services are listed in the names-based registry; 4) providing local health jurisdictions with limited access to the state HIV registry; 5) collecting more information at the t me of a preliminary positive HIV test; 6) publishing data on numbers of HIV...

How Can California Overcome Barriers to Expanding CARE/HIPP Enrollment?

The Comprehensive AIDS Resources Emergency/Health Insurance Premium Payment Program (CARE/HIPP) subsidizes private insurance premiums for low income persons living with HIV (PLWH) who are disabled and unable to work. Many of these PLWH would otherwise be eligible to receive medication through the AIDS Drug Assistance Program (ADAP). Cost-benefit analyses demonstrate that it costs more than twice as much to provide HIV drugs through ADAP as through CARE/HIPP. Thus, expanding CARE/HIPP enrollments could relieve pressure on ADAP budgets. This Policy Brief proposes policy changes needed to overcome barriers to increased CARE/HIPP enrollments, including: 1) Aligning eligibility requirements for ADAP and CARE/HIPP,...

Evaluating Patient-Centered Medical Homes (PCMH) for HIV Care

UCSF investigators are evaluating the effectiveness of Patient- Centered Medical Home (PCMH) demonstration projects, which were recently funded through a initiative from the California HIV/AIDS Research Program (CHRP). This work is part of the APRC’s commitment to studying the effectiveness of innovative models of care recommended by the CHRP-sponsored Visioning Change Initiative. The new PCMHs are community-based care systems that aim to provide coordinated, high quality, client-centered services for persons with HIV/AIDS. Interest in the PCMH model is driven by the changing nature of the HIV epidemic and the United States healthcare system. HIV increasingly affects underserved and older populations...

Understanding the implementation of Pre-Exposure Prophylaxis (PrEP) to prevent HIV in California

Scientists announced the results of the iPrex trial in November 2010, showing that overall, a daily dose of Truvada, a combination of two oral antiretroviral drugs, tenofovir disoproxil fumarate and emtricitabine, reduced HIV infection in a sample of high-risk men who have sex with men (MSM) and transgender (TG) women by 44 percent. Among those study participants who took Truvada 90 percent of the time, the effect increased to a 73 percent reduction in new infections. While these findings are significant, and have implications for the HIV prevention arena, it is unclear how the trial results will be understood and...

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