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

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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.