The Impact of ACA and Medicaid Expansion on Progress Toward UNAIDS 90-90-90 Goals
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Purpose of Review
Passage of the Affordable Care Act (ACA) in 2010 and subsequent Medicaid expansion has influenced access to HIV treatment and care in the USA. This review aims to evaluate whether the implementation of these policies has impacted progress toward UNAIDS 90-90-90 goals.
Preliminary evidence has emerged suggesting that the ACA and Medicaid expansion has increased the likelihood of HIV testing and diagnosis, reduced the number of people unaware of HIV infection, and increased the number of people on antiretroviral therapy (ART) who are virally suppressed.
While the ACA is associated with some progress toward 90-90-90 goals, more years of data after policy implementation are needed for robust analysis. Methods including difference-in-differences, instrumental variables, and propensity scores are recommended to minimize bias from unmeasured confounders and make causal inference about non-random Medicaid expansion among states.
KeywordsAffordable Care Act Medicaid expansion HIV 90-90-90 Viral suppression Policy analysis
Affordable Care Act
AIDS Drug Assistance Program
Behavioral Risk Factor Surveillance System
Centers for Disease Control and Prevention
Federal Poverty Level
human immunodeficiency virus
men who have sex with men
people living with HIV
Ryan White HIV/AIDS Program
Joint United Nations Program on HIV/AIDS
We would like to thank Anirban Basu for the input on policy analysis methods for causal inference using observational data. Lisa McLoughlin provided technical editing.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no competing interests.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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