Student Theses, Dissertations and Capstones

Document Type

Dissertation - NSU Access Only

Degree Name

Doctor of Philosophy (PhD) in Pharmacy

First Advisor

Ioana Popovici

Second Advisor

Silvia Rabionet

Defense Date

1-1-2023

Abstract

Background: The lifetime cost for one HIV infection is $326,500, and the medical cost saved from one averted infection is $229,800. Plans for ending the epidemic in the U.S involves the use of antiretroviral drugs as preexposure prophylaxis (PrEP), a major prevention strategy for reducing HIV infections. However, PrEP use has not been proportional to the need. Despite comparable HIV risk as men, women account for only 5% of PrEP users annually. Research suggests that PrEP ue is highest in states that expanded Medicaid. The gender disparity in PrEP use, however, suggests that other factors specific to women may be negatively impacting their PrEP uptake. The goal of this study was to therefore determine the factors influencing the PrEP use for women across the U.S. using data dating back to 2012, when PrEP was first approved. Methods: This quasi-experimental study used a difference-in-differences regression model to examine the effect of access to healthcare on PrEP use for men and women across the U.S. We hypothesized that states with expanded Medicaid, with greater availability of mental health and substance use disorder treatment, and with greater concentration of family planning clinics are associated with higher PrEP use in women. Results: The results showed that average PrEP use was higher in states that expanded Medicaid, but men had consistently higher PrEP use than women across states. The difference-in-differences model showed a larger percentage increase in both PrEP rate (18.9% v 8.1%) and PNR (42.9% v 17.6%) for men compared with women. Conversely, the availability of healthcare services did not have the expected effect on PrEP use. Conclusions: We identified a need for more tailored interventions to better reach women, by scaling up prevention efforts that are targeted at identifying and engaging women in PrEP care. This study provided a basis for further implementation research and policy changes that prioritizes equity for all.

Subject Categories

Pharmacy and Pharmaceutical Sciences

Keywords

Gender disparity; HIV prevention; Medicaid; Preexposure prophylaxis; PrEP; Women

Download
To access this thesis/dissertation you must have a valid nova.edu OR mynsu.nova.edu email address and create an account for NSUWorks.

Free My Thesis

If you are the author of this work and would like to grant permission to make it openly accessible to all, please click the Free My Thesis button.

  Contact Author

Share

COinS