Assessing the Impact of Economic Policies on the Use of Pre-Exposure Prophylaxis in the United States

项目摘要 虽然 涉及 PrEP 情况 变化 基于， 项目将 策略， 对避孕套使用和艾滋病毒检测的次要影响。 社会行为的 他们的 2 男男性接触者 PrEP 这些 数学 政策 等 最近的联邦和州政策旨在鼓励PrEP（暴露前预防）， (a)使基于药房的PrEP递送成为可能1，（B）利用医疗补助计划的益处来促进 (i.e.,取消事先授权，远程医疗提供的PrEP覆盖范围，以及有针对性的 （c）规定零费用分摊3 -被认为是最重要的 发生在PrEP 4 -中，其影响尚不清楚。通过实施一个理论- 多层次、纵向分析公共卫生政策 确定有效实现终止艾滋病毒流行目标的政策。- 13 Aim 1将整合 处方数据，调查和消费者数据，以隔离政策对PrEP使用的影响 目标2将扩大我们的纵向数据库， PrEP使用的决定因素，包括态度，规范和行为控制，并探索 在公共卫生政策与PrEP吸收和持久性之间的关系中发挥中介作用。目标1和 将模式l a）美国人口，（B）MSM（男男性行为者），以及（c）黑人、西班牙裔和白色 目标3将进一步审查目标1中研究的政策的有效性， 对一般MSM和黑人、西班牙裔和白色MSM之间HIV传播的建模效果。 三个目标将通过计量经济学、大数据、统计学和 方法.首先，差异中的差异方法将比较干预领域， 已实施并控制未实施该政策的区域，同时调整未测量的混杂因素 文化或人口统计学上的差异。第二，大数据分析 C 6 影响PrEP吸收和持久性，这 7 和 ( S , 将评估心理社会学 不同地区使用PrEP的决定因素，并调查政策在引发行为方面的作用。 变化第三、 的 重要 人口 奖 这些结果将为基于病原体的艾滋病毒传播模型提供信息， 针对男男性行为者的干预措施，同时考虑到国家种族/民族差异。法亚兹-法尔哈德博士 有助于了解针对边缘化群体的干预措施的有效性 他是一位在艾滋病领域有着丰富经验的资深研究员。K01 将通过在几个关键领域的培训来扩展她的轨迹：（i）艾滋病毒流行病学，（ii） 态度和行为，（三）健康不平等，（四）先进的方法技能。 提供 其 项目 跨领域 行为 K 01将 培训和指导作为她作为独立调查员职业生涯的基础 研究将有助于改善易受艾滋病毒感染人群的医疗保健服务。这 与NIAID的战略目标完全一致，并直接与艾滋病研究办公室保持一致 减少艾滋病毒在重点人群中的发病率， 和社会科学为艾滋病护理。

PROJECT SUMMARY Although involve PrEP case changes based, project will policies, secondary impact on condom use and HIV testing. social-behavioral their 2 MSM. PrEP These mathematical policy such recent federal and state policies targeted t o encourage PrEP (pre-exposure prophylaxis) — which (a) enabling pharmacy-based PrEP delivery 1 , (b) leveraging Medicaid program's benefits to promote (i.e., removal of prior authorization, coverage of telemedicine-delivered PrEP, and overage of targeted management) 2 , and (c) mandating zero-cost sharing 3 — have been described as the most significant that have happened with PrEP 4 – , their impact is not well understood. By implementing a theory- multi-level, longitudinal analysis of how public health policies identify policies to efficiently achieve the Ending the HIV Epidemic goals. – 13 Aim 1 will integrate prescription data, surveys, and consumer data to isolate the effects of the policies on PrEP use Aim 2 will expand our longitudinal database to include determinants of PrEP use, including attitudes, norms, and behavioral control, and explore mediating role in the relation between public health policies and PrEP uptake and persistence. Aims 1 and will mode l a) the US population, (b) MSM (men who have sex with men), and (c) Black, Hispanic, and White Aim 3 will f urther examine the effectiveness of the policies studied in Aim 1 by moving from effects on t o modeling effects on HIV transmission among MSM in general and Black, Hispanic, and White MSM. three aims will be achieved through an innovative combination of econometric, big data, tatistical, and methods. First, a difference in differences method will compare intervention areas in which a has been implemented and control areas without the policy while adjusting for unmeasured confounders as differences in culture or demographics. Second, big data analyses c 6 affect PrEP uptake and persistence, this 7 and ( s , will assess psychosocial determinants of PrEP use for different regions and investigate the role of the policies in eliciting behavioral change. Third, of important populations Award these results will inform an agent-based model of HIV transmission that will project the impact the interventions for MSM, taking into account national race/ethnic disparities. Dr. Fayaz-Farkhad has made contributions to understanding the effectiveness of interventions targeted for marginalized and is an accomplished junior researcher with ample experience in the field of HIV. This K01 will extend her trajectory with training in several key areas:(i) HIV epidemiology, (ii) the science of attitudes and behavior, (iii) health inequalities, and (iv) advanced methodological skills. provide whose project cross-cutting Behavioral The proposed K01 will training and mentorship to serve as the foundation for her career as an independent investigator research will serve to improve healthcare access for populations vulnerable to HIV infection. This is well-aligned with NIAID's strategic objectives and directly in line with the Office of AIDS Research areas of Health Disparities to reduce the incidence of HIV in priority populations and utilize and Social Sciences for HIV care.