- Press Release Distribution

Medicaid expansion helps uncover undiagnosed HIV infections

Medicaid expansion helps uncover undiagnosed HIV infections
( CHAMPAIGN, Ill. -- The Medicaid expansion facilitated by the Affordable Care Act led to increases in the identification of undiagnosed HIV infections and in the use of HIV prevention services such as preexposure prophylaxis drugs, says new research co-written by a team of University of Illinois Urbana-Champaign experts who study the intersection of health care and public policy.

The research by Dolores Albarracín, a professor of psychology and of business administration at Illinois, and Bita Fayaz Farkhad, an economist and a postdoctoral researcher in psychology at Illinois, found that expanding eligibility for Medicaid, the federal-state health insurance program for low-income individuals, was associated with a 13.9% increase in HIV diagnoses.

The newly discovered infections were concentrated among those likely to be affected by the health insurance expansion: individuals engaged in injection drug use in low-income and rural counties with a high share of pre-ACA uninsured rates.

The changes in new HIV diagnoses, awareness of HIV status and additional PrEP use were not simply due to an increase in HIV infections or to an increase in infection risk, but to the expanded access of health insurance through the Medicaid program, the researchers said.

"We find that HIV diagnoses increased in Medicaid expansion states compared with nonexpansion states, and that the general knowledge that HIV can be prevented through prophylaxis drugs also increased," said Farkhad, the lead author of the research. "When we consider these two findings together, our conclusion is that access to health care and health insurance has increased the percentage of people living with HIV who are aware of their status, which is an important finding for HIV prevention efforts. According to 2016 Centers for Disease Control and Prevention estimates, a high proportion of new HIV infections were transmitted by people who were unaware of their HIV-positive status."

"Increasing community awareness of HIV and increasing individuals' awareness of their HIV status is key to reducing new infections," said Albarracín, also the director of the Social Action Lab at Illinois. "This study provides important evidence suggesting that increasing health insurance coverage may play a critical role in curbing the spread of HIV."

The researchers analyzed the effects of the Medicaid expansion using data from 2010-17 on HIV diagnoses per 100,000 population, awareness of HIV status and PrEP use by calculating differences in new diagnoses and PrEP use before and after states adopted the expansions. They compared the differences between treatment counties - that is, all counties in states that expanded Medicaid - versus control counties in states that didn't expand Medicaid.

As access to health insurance and HIV testing improved with the health insurance expansions, a higher percentage of people living with HIV were newly aware of their status, as reflected in rising numbers of HIV diagnoses.

"Although many social factors contribute to rural-urban and other social-health disparities, health insurance accounts for much of the variation in access to care. Hence, expanding health insurance coverage has important implications for HIV prevention and disease transmission," Farkhad said.

"A popular misconception of the ACA" - former President Obama's signature health care law - "is that it's an unwieldy failure of health care policy," Albarracín said. "But our research points to that being false, as the Medicaid expansion prong of 'Obamacare' has been quite successful, providing evidence that expanding access to health insurance is associated with improvements in several HIV-related outcomes. This is clearly one measure that is not a failure in terms of people's lives and health."

Another finding is that the main increase in new HIV diagnoses stems from intravenous drug injection.

"This finding is not surprising given that the U.S. is in the midst of an opioid crisis, and the increase in injection drug use has led to a greater risk of illness due to needle sharing," Farkhad said. "Because there is no evidence that Medicaid expansions affected substance use, the increase in HIV diagnoses attributed to injection is consistent with the improved access to care among those with substance use disorder. Also, people with substance use disorders were more likely to be uninsured prior to the ACA than the general population, which further reinforces the idea that expanding Medicaid is a good thing for public health."

The study has important health policy implications, the researchers said.

"It's a very important lesson in terms of, if you want to eradicate HIV, you're going to have to increase health coverage," Albarracín said. "Otherwise, HIV will continue to spread under the public health radar. The findings about drug use are also important because our team is leading an initiative to prevent HIV infections associated with drug use in 200 counties in Appalachia and the Midwest."

"For COVID-19, public health officials are constantly emphasizing how important it is for people to test, test, test," Farkhad said. "And it's the same idea here. We show how important it is to have insurance coverage to increase testing, and that those extra tests were necessary and have increased the rate of HIV diagnosis.

"It also speaks to the role of access to affordable health care plans. The states that didn't expand Medicaid, especially the Southern states where opioid use is prevalent, have a very high rate of uninsured compared to other states. Expanding insurance coverage to low-income individuals through Medicaid could facilitate HIV prevention and improve HIV-related health outcomes."


The paper was published in the American Journal of Preventive Medicine.

David R. Holtgrave of the University of Albany was a co-author of the research.

The research was supported by the National Institute of Allergy and Infectious Diseases and the National Institute of Drug Abuse.

[Attachments] See images for this press release:
Medicaid expansion helps uncover undiagnosed HIV infections


Building a corn cob--cell by cell, gene by gene

Building a corn cob--cell by cell, gene by gene
Corn hasn't always been the sweet, juicy delight that we know today. And, without adapting to a rapidly changing climate, it is at risk of losing its place as a food staple. Putting together a plant is a genetic puzzle, with hundreds of genes working together as it grows. Cold Spring Harbor Laboratory (CSHL) Professor David Jackson worked with Associate Professor Jesse Gillis to study genes involved in corn development. Their teams analyzed thousands of individual cells that make up the developing corn ear. They created the first anatomical map that shows where and when important ...

Hospital worker flu shots could mean fewer deaths

Pneumonia and the flu kill tens of thousands of Americans each year, racking up billions of dollars in medical costs and even more in lost productivity. But new research from the University of Georgia shows that state laws promoting flu vaccinations for hospital workers can substantially reduce the number of influenza-related deaths. Spanning 23 years, the study looked at the mortality rate from influenza and pneumonia during peak flu season (from December through March of each year), comparing changes in mortality over time in the 13 states and Washington, D.C., that adopted laws to the changes in mortality in states without laws. ...

Invasive mussels now control a key nutrient in the American Great Lakes

Invasive mussels now control a key nutrient in the American Great Lakes
The health of aquatic ecosystems depends on the supply of key nutrients, especially phosphorus. Too much phosphorus results in unwanted eutrophication, and much effort is spent on preventing phosphorus pollution of water bodies. In the World's largest freshwater ecosystem, the North American Great Lakes, this control may have recently been lost to an invasive species. According to a new study, quagga mussels, which have spread across four of the five Great Lakes, have accumulated large amounts of phosphorus in their biomass, to the degree that their activities now regulate the supply of phosphorus ...

Marketing has major benefits for entrepreneurs in emerging markets, study shows

Their field may not be top of mind among those that contribute to the greater good, yet new research from the University of Notre Dame shows marketers can help entrepreneurs in emerging markets grow their businesses, which in turn helps them to improve lives, sustain livelihoods, enhance overall living standards and strengthen societies. "Do Marketers Matter for Entrepreneurs? Evidence from a Field Experiment in Uganda" is forthcoming in the Journal of Marketing from Frank Germann, an associate professor of marketing at Notre Dame's Mendoza College of Business who teaches ...

Anonymous cell phone data can quantify behavioral changes for flu-like illnesses

Cell phone data that is routinely collected by telecommunications providers can reveal changes of behavior in people who are diagnosed with a flu-like illness, while also protecting their anonymity, a new study finds. The Proceedings of the National Academy of Sciences (PNAS) published the research, led by computer scientists at Emory University and based on data drawn from a 2009 outbreak of H1N1 flu in Iceland. "To our knowledge, our project is the first major, rigorous study to individually link passively-collected cell phone metadata with actual public health data," says Ymir Vigfusson, assistant professor in Emory University's Department of Computer Science and a first author of the study. "We've shown ...

Metamaterial tiles boost sensitivity of large telescopes

WASHINGTON -- A multi-institutional group of researchers has developed new metamaterial tiles that will help improve the sensitivity of telescopes being built at the preeminent Simons Observatory in Chile. The tiles have been incorporated into receivers that will be deployed at the observatory by 2022. The Simons Observatory is the center of an ambitious effort to measure the cosmic microwave background -- electromagnetic radiation left over from an early stage of the universe -- using some of the world's largest and most sophisticated ground-based telescopes. ...

Anti-poverty policies can reduce reports of child neglect

Providing economic relief to struggling families can lead to another positive effect -- fewer cases of child neglect, according to new research by the University of Washington. A 10% increase in a common benefit for low- to moderate-income working families, the Earned Income Tax Credit, led to a 9% decrease in the annual number of reports of child neglect made to child welfare agencies over a 14-year study period. That's a significant impact, researchers say, and can inform future social policies. The study is relevant to current policy actions, as President Joe Biden has recently proposed an expansion ...

Kombucha tea sparks creative materials research solution

Kombucha tea sparks creative materials research solution
RESEARCH TRIANGLE PARK, N.C. -- Kombucha tea, a trendy fermented beverage, inspired researchers to develop a new way to generate tough, functional materials using a mixture of bacteria and yeast similar to the kombucha mother used to ferment tea. With Army funding, using this mixture, also called a SCOBY, or symbiotic culture of bacteria and yeast, engineers at MIT and Imperial College London produced cellulose embedded with enzymes that can perform a variety of functions, such as sensing environmental pollutants and self-healing materials. The team also showed that they could incorporate yeast directly into the cellulose, creating living materials that could be used to purify water for Soldiers in the field or make smart packaging materials that can detect damage. "This ...

Genetically-modified mosquitoes key to stopping Zika virus spread

Genetically-modified mosquitoes key to stopping Zika virus spread
COLUMBIA, Mo. - In 2016, the World Health Organization called the Zika virus epidemic a "public health emergency of international concern" due to the virus causing birth defects for pregnant women in addition to neurological problems. Since then, researchers have wrestled with different strategies for controlling the spread of Zika virus, which gets transmitted to humans from female mosquito bites. One approach, which was approved by the Environmental Protection Agency in May, will release more than 750 million genetically modified mosquitos into the Florida Keys in 2021 and 2022. These "suicide mosquitos" are genetically-altered to produce offspring that die before emerging into adults and therefore cannot ...

Study provides first real-world evidence of Covid-19 contact tracing app effectiveness

An international research collaboration, involving scientists from the UK, US and Spain, has shed new light on the usefulness of digital contact tracing (DCT) to control the spread of Covid-19. The study, published today in Nature Communications, assessed the effectiveness of the Spanish DCT app, Radar COVID, following a 4-week experiment conducted in the Canary Islands, Spain between June-July 2020. For the experiment, funded by the Secretary of State of Digitalisation and Artificial Intelligence (SEDIA), the researchers simulated a series of Covid infections in the capital of La Gomera, San Sebastián de la Gomera, to understand whether the Radar COVID app technology could ...


When foams collapse (and when they don't)

Predicts the onset of Alzheimer's Disease (AD) using deep learning-based Splice-AI

Oahu marine protected areas offer limited protection of coral reef herbivorous fishes

'Explicit instruction' provides dramatic benefits in learning to read

Deep brain stimulation and exercise restore movement in ataxia

Atherosclerosis can accelerate the development of clonal hematopoiesis, study finds

Picture books can boost physical activity for youth with autism

Cancer: a new killer lymphocyte enters the ring

When using pyrite to understand Earth's ocean and atmosphere: Think local, not global

New insights into an ancient protein complex

Meteorites remember conditions of stellar explosions

Cerium sidelines silver to make drug precursor

Researchers identify characteristics of highest utilizers for mental health hospital services

Research reveals how bacteria defeat drugs that fight cystic fibrosis

Sensing robot healthcare helpers being developed at SFU

Agents of food-borne zoonoses confirmed to parasitise newly-recorded in Thailand snails

New tools find COVID patients at highest risk of mechanical ventilation and death

Exposure to diverse career paths can help fill labor market 'skills gap'

Engineering the boundary between 2D and 3D materials

Republican and Democratic voters agree on one thing--the need for generous COVID-19 relief

New study highlights importance of context to physical theories

Quantum quirk yields giant magnetic effect, where none should exist

Considering disorder and cooperative effects in photon escape rates from atomic gases

Blood tests offer early indicator of severe COVID-19, study says

New research finds exercise may help slow memory loss for people living with Alzheimer's dementia

Using neutron scattering to better understand milk composition

Unburdening China of cancer: Trend analysis to assist prevention measures

Measuring the tRNA world

Household transmission of SARS-CoV-2

When young people start smoking

[] Medicaid expansion helps uncover undiagnosed HIV infections