Publications

Initial Health Assessments and HIV Screening Under the Affordable Care Act

The Centers for Disease Control and Prevention (CDC) estimates that 156,300 (95% CI 144,100–165,900) Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers. We surveyed all ten California health plans offered under health reform’s Insurance Exchange (response rate = 50%) ... [Read More];

Identifying a Sample of HIV-Positive Beneficiaries From Medicaid Claims Data and Estimating Their Treatment Costs

We sought to identify people living with HIV/AIDS from Medicare and Medicaid claims data to estimate Medicaid costs for treating HIV/AIDS in California. We also examined how alternate methods of identifying the relevant sample affect estimates of per capita costs. We analyzed data on Californians enrolled in Medicaid with an HIV/AIDS diagnosis reported in 2007 Medicare or Medicaid claims data. We compared alternative selection criteria by examining use of antiretroviral drugs, HIV-specific monitoring tests, and medical costs. We compared the final sample and average costs with other estimates of the size of California’s HIV/AIDS population covered by Medicaid in 2007 ... [Read More];

TasP, PEP, and PrEP: New Hope in the Fight Against HIV/AIDS

The HIV/AIDS community is currently talking about “ending the AIDS epidemic” or “achieving an AIDS-free generation.” This conversation–optimistic, speculative, and sometimes controversial–focuses on three evidence-based HIV prevention interventions: Treatment as Prevention (TasP), Post-Exposure Prophylaxis (PEP), and Pre-Exposure Prophylaxis (PrEP). All three interventions utilize existing anti-retroviral medications to reduce transmission of HIV and prevent new infections in at-risk HIV-negative individuals. Recent research documents the potential efficacy of these interventions and the promise they hold. The purpose of this fact sheet is to explain these interventions, the data that supports them, and how Californians living with and at-risk of HIV infection will ... [Read More];

The Use of HIV Over-the Counter (OTC) test in California from April to September 2013

Approval in mid-2012 of a consumer-controlled OTC HIV test by the Food and Drug Administration (FDA), which is responsible for drug and medical device approval for sales to the public, has made real the possibility of learning one’s HIV status in the privacy of one’s home. Now, people who are concerned about the potential embarrassment or stigma associated with receiving an HIV test from their medical provider or in a publicly-funded HIV testing site can bypass these issues to obtain a 20-minute test result if they were willing to spend the $40-$50 to purchase an OTC HIV test at a ... [Read More];

HIV Tests And New Diagnoses Declined After California Budget Cuts, But Reallocating Funds Helped Reduce Impact

Historically, California supplemented federal funding of HIV prevention and testing so that Californians with HIV could become aware of their infection and obtain lifesaving treatment. However, budget deficits in 2009 led the state to eliminate its supplemental funding for HIV prevention. We analyzed the impact of California’s HIV resource allocation change between state fiscal years 2009 and 2011. We found that the number of HIV tests declined 19 percent, from 66,629 to 53,760, in local health jurisdictions with high HIV burden. In low-burden jurisdictions, the number of HIV tests declined 90 percent, from 20,302 to 2,116. New diagnoses fell from ... [Read More];

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