New paper in @Health_Affairs 📰. HIV #PrEP costs are a frequently cited barrier to ⬆️ PrEP uptake. But the coverage landscape has changed significantly in recent yrs. We looked at uncovered costs for PrEP in the US. Read the 🧵 to learn more 👇.

Howard Hiatt was unfailingly kind and a generous mentor to many. I’m especially grateful for his vision to create and support a Division and residency training track in global health equity, both of which I benefited from greatly.

RT @AIDS_Journal: We are pleased to publish this Editorial Review by Jesse O'Shea, @RobertBonacci et al. HIV and mpox: a rapid review.htt….

RT @mounicav07: Access to precision oncology therapeutics is limited by access to sophisticated molecular diagnostics. @ritikulocyte , Quin….

RT @DMLopez5: Amazing start to the @BrighamMedRes Reunion Weekend with our 2016 Intern Class Dinner! Yes, we were those rowdy interns at Mo….

RT @Health_Affairs: Although HIV #PrEP is highly effective in reducing rates of HIV acquisition, cost remains a barrier to access. @RobertB….

RT @CarlosdelRio7: Estimating Uncovered Costs for HIV PrEP in the US. @Health_Affairs @CDC_HIV out of 1.2 M US adul….

@HoltgraveHealth @pssinatl @jenkatesdc @LindseyH_Dawson @OjikutuBisola @khmayer1 @JuliaLMarcus @aekillelea @CarlosdelRio7 @Armstrws @HIVpxresearch @amfAR @PrEP4AllNow @NASTAD @NMACCommunity @AIDS_United @dr_demetre @CDC_HIV @DrMerminCDC.

14/ Read a wonderful tribute to Dawn's life here:.

13/ Lastly, Dawn Smith, who passed away in late 2022, was this study's senior author. A wonderful mentor, friend, and tireless advocate for PrEP and equity in HIV prevention, this effort is dedicated to her memory.

12/ Our study shows that we've made significant progress in reducing financial barriers to PrEP. But barriers remain. If we are to achieve the goals of the Ending the HIV Epidemic initiative, we must address all barriers with equity at the core of our efforts to ⬆️ PrEP uptake.

11/ Multiple proposals to establish and fund a national PrEP program have been released. @POTUS has proposed $237 million for this in his FY2024 proposed budget. See more here:

10/ So where do we go next? . $102 million annually in uncovered PrEP is still significant. Further ⬇️ number of uninsured through Medicaid expansion, especially in the South, and ⬆️ PrEP assistance programs could address financial barriers.

9/ Barriers persist at every step of the PrEP continuum:. -Lack of awareness/knowledge (patient & clinician).-Stigma.-Distrust of medical system.-Systemic racism, transphobia, homophobia.-Geographic and transportation barriers.-Many others. See more here:

8/ What does this mean for PrEP?. Reaching those who need PrEP will require more than just addressing financial barriers. In fact, our study suggests this may not be the main barrier for most people who could benefit from PrEP.

7/ Why did uncovered costs for PrEP ⬇️?. ⬇️ in uninsured, owing to the ACA and Medicaid expansion. Introduction of generic PrEP led to ⬇️ cost of PrEP (generics available for as little as $30/mo). Higher % of people with uncovered costs eligible for 💊 assistance.

6/ ~50k people would still face financial barriers to PrEP, ⬇️ from ~94k in 2015. Notably, 95% with uncovered costs would only require assistance for clinic visits and labs. That's because most would qualify for medication assistance programs.

5/ We found, after accounting for insurance and PrEP assistance programs, that uncovered costs for PrEP have dropped by >50% since 2015!. ~$208 million/yr in 2015 --> ~$102 million/yr in 2018

4/ While uptake has lagged, the PrEP coverage landscape has changed a lot. 1. ACA and Medicaid expansion ⬆️ insurance access. 2. Generic PrEP ⬇️ 💊 costs. 3. USPSTF grade A rec for oral PrEP ⬇️ cost sharing for PrEP (for most). though recent court ruling may impact this.

3/ Dawn Smith led a study that estimated ~94k people, or 8% of the people who could benefit from PrEP had uncovered costs for PrEP in 2015. The study also estimated a total cost of >$200 million/yr to meet those financial needs.

2/ 1.2 million people in the US could benefit from PrEP 💊, but only 30% of those individuals receive it. And racial disparities persist. PrEP coverage for White people is much higher than for Black or Latino people. Also higher for men than women.