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Pep and pr ep cranston


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Pep and pr ep cranston

  1. 1. Getting Past the Barriers:A State Works to Make PrEP Available SYNChronicity Connecting to Change To Advance Community Health April 20-21, 2012 Arlington, VA Kevin Cranston, MDiv Director Bureau of Infectious Disease Massachusetts Department of Public Health
  2. 2. Is MA Comparable to Other States?• Relatively affluent (3rd highest per capita income in U.S.)• Densely populated (3rd densest in U.S.)• Decreasing HIV incidence (down 52% since 2000)• Generous Medicaid program (first Medicaid HIV waiver; coverage at 200% of FPL)• First statewide health reform legislation (98% coverage)• Significant state investment in HIV services ($31M; highest per person living with HIV/AIDS in U.S.)
  3. 3. But our challenges are the same• MSM is the predominant HIV exposure mode• Ongoing racial/ethnic health disparities• Hit hard by the global economic crisis• ASOs challenged to survive• Operate under the same limitations of CDC and HRSA/Ryan White HIV funding
  4. 4. Problems to addressed to implement PrEP• Payment source(s)• Limits of current off-label use of Truvada• Challenges of building interest among MSM and their health care providers• Challenge of engaging those at highest risk• How to support needed range of medical monitoring services to surround PrEP• Concerns about reinforcing health disparities• Other ethical considerations
  5. 5. Strategies to PrEPare• Reprocurement of prevention and screening contracts to create readiness for targeted implementation of PrEP; seven agencies qualified: AGENCY Region Western/ Berkshire Medical Center Pittsfield Boston Medical Center Boston Southeast/ Cape Cod Hospital/IDCS Cape Cod Central - Edward M. Kennedy CHC Worcester Fenway Health Boston Greater Lawrence Family Northeast/ Health Center Lawrence Greater New Bedford Southeast/ Community Health Center New Bedford
  6. 6. Strategies to PrEPare• Distributed MDPH position statement and CDC and HRSA guidances to MA providers• Formed a PrEP Clinical Advisory Group• Defined an intensive prevention services package: – repeat HIV testing, STI screening and treatment, HIV and STI Partner Services, condom availability, ongoing behavioral risk assessment, prevention counseling)• Drafted supplementary data collection forms: – Initial PrEP interest form – Initial client data collection form – Follow-up client data collection form – PrEP discontinuation form
  7. 7. Strategies to PrEPare• Participated in calls with CDC and other interested jurisdictions: – New York State – San Francisco – Los Angeles – Washington, DC
  8. 8. Strategies to PrEPare• Medicaid demonstration project planning: – developing a PrEP demonstration project – test the adequacy of reimbursement under Medicaid – feasibility of administering PrEP (inclusive of clinician time, medications, lab services, and prevention counseling) to low income patients in a Medicaid coverage environment
  9. 9. Strategies to PrEPare• Review of Medicaid coverage of Truvada monotherapy – 30-80 scrips and unique utilizers per month – Indicative of nPEP and/or PrEP use of drug? – 800-1,200 combination therapy claims – Limitations of billing information – Establishes pattern of coverage
  10. 10. Next Steps• Survey clinical providers regarding current and anticipated PrEP demand and use• Link funded prevention and screening providers to likely PrEP prescribers• Planned meeting with state Office of Medicaid, selected members of PrEP Clinical Advisory Group, and funded P&S providers• Implement data collection forms
  11. 11. Thank