Impact of Prescription Caps on Health Outcomes in People Infected with HIV

处方上限对艾滋病毒感染者健康结果的影响

• 批准号: 10334016
• 负责人: Omar Galarraga
• 金额: $ 10万
• 依托单位: BROWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10334016
• 关键词: Address; Adherence; Administrative Supplement; Adoption; Adult; Affect; Algorithms; Anti-Retroviral Agents; Birth; Budgets; Caring; Chronic; Communities; Cost Control; Data; Drug Costs; Drug Prescriptions; Economics; Enrollment; Ensure; Equilibrium; Evaluation; Face; Funding; Future; Gender; Gender Identity; General Population; Goals; Grant; HIV; Health; Health Care Costs; Health Services Research; Healthcare; High Prevalence; Hormone use; Hormones; Hospitals; Intervention; Lead; Life; Life Expectancy; Low income; Medicaid; Medical; Medical Care Costs; Mental Health; Mentally Ill Persons; Morbidity - disease rate; Names; Operative Surgical Procedures; Outcome; Parents; Personal Satisfaction; Persons; Pharmaceutical Preparations; Policies; Population; Population Heterogeneity; Public Assistance; Research; Research Personnel; Risk; Sampling; Savings; Series; Sexual Transmission; Societies; Texas; Time; Translations; United States National Institutes of Health; Ursidae Family; Viral; Vulnerable Populations; Work; adverse outcome; antiretroviral therapy; beneficiary; cisgender; comorbidity; cost; design; economic cost; economic impact; experience; health care availability; health disparity; health economics; health inequalities; interest; medically necessary care; medication compliance; member; mortality; novel; parent grant; peer; population health; prescription drug costs; pressure; programs; psychological distress; response; sex; socioeconomics; therapy adherence; transgender; transmission process; uptake

PROJECT SUMMARY Transgender and gender diverse (TGD) people, who have a gender identity that differs from their assigned birth sex and who may use hormones to affirm their gender, are disproportionately affected by HIV. Antiretroviral therapy (ART) greatly reduces HIV-related morbidity and mortality for those who are adherent and able to achieve viral suppression. However, many TGD people with HIV face barriers to ART adherence, including the inability to pay for medications. This study seeks to examine the health and economic impact of Medicaid prescription caps for TGD people living with HIV–an NIH priority population. Prescription caps represent a cost- containment strategy employed by some state Medicaid programs that limit the number of brand name drugs or total number of prescriptions that may be filled in a given time window, typically per month. Though a few outdated studies have used Medicaid data to evaluate the impact of prescription caps on the health of members of the general population, until now, this has not been studied among TGD people. Relative to cisgender (non- TGD) people, TGD people are not only at greater risk for HIV and other chronic conditions but also face economic constraints and competing gender affirmation needs, including the necessary use of gender-affirming hormones to alleviate psychological distress.35,39 In the face of prescription caps, people with HIV have to make tradeoffs between which medications to use and we hypothesize that this tradeoff will lead to lower ART adherence, health complications, and additional medical costs for both TGD and cisgender people with HIV. However, given the documented health comorbidities, economic constraints, and gender affirmation needs that TGD people disproportionately experience, we hypothesize that when faced with prescription caps, TGD people with HIV will have lower levels of medication adherence and worst health outcomes than their cisgender counterparts. Health services research involving Medicaid claims data has not historically accounted for TGD people as Medicaid data does not include a reliable indicator of TGD status. In response to the NIH’s expressed interest to conduct feasible, efficient, and rigorous research, we aim to apply novel algorithms developed by our team to identify TGD and cisgender people with HIV in Medicaid data and study the impact of medication caps on the health of these populations. Specifically, will build off the parent grant by using Medicaid data to explore the differential impact of prescription caps on ART adherence for TGD and cisgender adults with HIV; evaluate whether hormone use moderates the relationship between prescription caps and ART adherence among TGD people alone; and estimate the potentially avoidable health and economic effects of medication caps and ART non- adherence for TGD and cisgender people with HIV. We will engage TGD researchers and community members throughout all stages of the study to ensure the cultural relevance of our work and the effective translation of our findings into future research and intervention strategies. By employing our novel analytic approaches, we will be able to identify disparities in medication access that can be addressed through future policy interventions to eliminate health inequities for some of the most vulnerable members of our society - TGD people living with HIV.

项目摘要 跨性别和性别多样化（TGD）的人，他们的性别认同与他们的出生不同 性行为和可能使用激素来确认其性别的人受到艾滋病毒的影响不成比例。抗病毒 抗逆转录病毒疗法（ART）大大降低了那些坚持并能够 实现病毒抑制。然而，许多TGD艾滋病毒感染者在坚持抗逆转录病毒治疗方面面临障碍，包括 无力支付医药费。这项研究旨在研究医疗补助对健康和经济的影响 TGD艾滋病毒感染者的处方上限-NIH优先人群。处方上限代表着一种成本- 一些州医疗补助计划采用的遏制策略，限制了品牌药物的数量， 可以在给定时间窗口（通常为每月）内填写的处方总数。尽管少数 过时的研究使用医疗补助数据来评估处方上限对成员健康的影响 到目前为止，还没有在TGD人群中进行过研究。相对于顺性（非 TGD患者不仅面临更大的艾滋病毒和其他慢性病风险，而且还面临经济困难。 限制因素和相互竞争的性别肯定需求，包括必须使用性别肯定激素 35，39面对处方上限，艾滋病毒感染者不得不做出权衡 我们假设这种权衡将导致较低的ART依从性， 并发症，以及TGD和顺性别艾滋病毒感染者的额外医疗费用。但鉴于 记录的健康共病，经济限制和性别肯定需要TGD人 不成比例的经验，我们假设，当面临处方上限，TGD的艾滋病毒感染者将 与顺性别者相比，他们的药物依从性较低，健康状况最差。健康 涉及Medicaid索赔数据的服务研究历史上没有将TGD人群视为Medicaid 数据不包括TGD状态的可靠指标。为了回应NIH表示有兴趣进行 可行的，有效的，严格的研究，我们的目标是应用我们的团队开发的新算法来识别 TGD和顺性别艾滋病毒感染者在医疗补助数据和研究药物上限对健康的影响 这些人口。具体来说，将通过使用医疗补助数据来探索差异， 处方上限对TGD和顺性别成人艾滋病毒感染者抗逆转录病毒治疗依从性的影响;评估是否 激素的使用缓和了TGD患者处方上限和ART依从性之间的关系 单独使用;并估计药物上限和非ART的潜在可避免的健康和经济影响， TGD和顺性别HIV感染者的依从性。我们将邀请TGD研究人员和社区成员 在研究的所有阶段，以确保我们的工作的文化相关性和我们的有效翻译 未来的研究和干预策略。通过使用我们新颖的分析方法，我们将 能够确定可通过未来政策干预解决的药物获取差距， 消除我们社会中一些最脆弱的成员-- TGD艾滋病毒感染者--的健康不平等。