PDF(Pubmed)
Abstract：
Pre-exposure prophylaxis (PrEP) has the potential to prevent new HIV infections, but it is unclear how state policies governing sexual and reproductive health services (SRH) impact access for cisgender women. The objective of this review is to identify barriers to PrEP access for cisgender women in the United States. Using the CDC Atlas Program, 20 states with the highest HIV incidence among cisgender women were included in this analysis. Through a search conducted in May-July 2022 of CDC, PrEPWatch.org, and other State Department and Insurance websites, Medicaid expansion status, pharmacist PrEP prescribing laws, financial support programs, and Traditional Medicaid coverage of PrEP, HIV testing, and emergency contraception were reviewed. Of the included states, nearly half did not expand Medicaid at the state level. Emergency contraception and HIV testing was covered under Traditional Medicaid for almost all included states, but insurance stipulations and eligibility requirements remain. Although PrEP is covered under all Traditional Medicaid plans, six states require pre-authorization. Three states have HIV testing mandates, four allow pharmacists to prescribe PrEP and six have financial support programs to cover the cost of PrEP. Medicaid expansion, pre-authorization requirements for PrEP prescriptions and emergency contraception, and limitations on pharmacist prescribing abilities were identified as barriers to SRH access for cisgender women. Medicaid expansion should be prioritized as an approach to expanding access to HIV prevention services at the state level.
摘要：
暴露前预防（PrEP）有可能预防新的HIV感染，但是尚不清楚管理性健康和生殖健康服务（SRH）的国家政策如何影响顺性女性的获取。这项审查的目的是确定美国顺性女性获得PrEP的障碍。使用CDCAtlas计划，该分析包括了在顺性女性中艾滋病毒发病率最高的20个州。通过CDC在2022年5月至7月进行的搜索，PrEPWatch.org,以及其他国务院和保险网站，医疗补助扩大状况，药剂师PrEP规定法律，财政支持计划，和PrEP的传统医疗补助覆盖，艾滋病毒检测,并对紧急避孕进行了审查。在包括的国家中，近一半的人没有在州一级扩大医疗补助。几乎所有州的传统医疗补助都涵盖了紧急避孕和艾滋病毒检测，但是保险规定和资格要求仍然存在。尽管所有传统医疗补助计划都涵盖了PrEP，六个州需要预先授权。三个州有艾滋病毒检测任务，其中4个允许药剂师开具PrEP处方,6个有财务支持计划来支付PrEP的费用.医疗补助扩大，PrEP处方和紧急避孕的预授权要求，药剂师处方能力的限制被认为是顺式女性获得SRH的障碍。医疗补助扩大应作为在州一级扩大获得艾滋病毒预防服务的一种方法。
