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

项目总结 变性人和性别多元化(TGD)人群，他们的性别认同与他们指定的出生性别不同 性行为和可能使用荷尔蒙确认性别的人，受艾滋病毒的影响不成比例。抗逆转录病毒 治疗(ART)极大地降低了那些坚持并能够 实现病毒抑制。然而，许多携带艾滋病毒的TGD患者在坚持抗逆转录病毒治疗方面面临障碍，包括 无力支付药费。这项研究旨在检查医疗补助对健康和经济的影响 TGD艾滋病毒携带者-NIH优先人群的处方上限。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，限制品牌药物的数量或 在给定时间窗口内可填写的处方总数，通常为每月。尽管有几个人 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 在一般人群中，到目前为止，这还没有在TGD人群中进行研究。相对于顺性别(非 TGD)人群，TGD人群不仅感染艾滋病毒和其他慢性病的风险更大，而且还面临经济困难 制约因素和相互竞争的性别平等需要，包括必要地使用性别平等荷尔蒙 以缓解心理痛苦。35、39面对处方上限，艾滋病毒携带者不得不做出权衡 在使用哪种药物和我们假设这种权衡将导致较低的ART依从性、健康 并发症，以及TGD和顺性别艾滋病毒携带者的额外医疗费用。然而，鉴于 TGD患者的健康合并症、经济限制和性别肯定需求 不成比例的经验，我们假设，当面对处方上限时，TGD艾滋病毒携带者将 与顺性同龄人相比，他们的服药依从性和最差的健康结果更低。健康状况 涉及医疗补助索赔数据的服务研究在历史上并未将TGD患者视为医疗补助 数据不包括TGD状态的可靠指标。在回应NIH表示有兴趣进行 可行、高效和严谨的研究，我们的目标是应用我们团队开发的新算法来识别 TGD和顺性别艾滋病毒携带者的医疗补助数据和研究药物上限对健康的影响 这些种群。具体地说，将通过使用医疗补助数据来探索差异，从而建立在父母补助金的基础上 处方上限对TGD和艾滋病毒携带者顺铂依从性的影响；评估是否 激素使用调节TGD患者处方上限与ART依从性之间的关系 并估计药物上限和非抗逆转录病毒药物的潜在可避免的健康和经济影响 TGD和顺性别艾滋病毒携带者的坚持。我们将与TGD研究人员和社区成员合作 在研究的所有阶段确保我们的工作与文化相关，并有效地翻译我们的 对未来研究和干预策略的研究结果。通过使用我们的新分析方法，我们将 能够确定可通过未来政策干预解决的药物获取方面的差异 消除我们社会中一些最脆弱的成员--TGD艾滋病毒携带者--的健康不平等。

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 Though a few outdated studies have used Medicaid data to evaluate the impact of prescription caps on the health of members of the general population, until now, this has not been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.