Expanding Medicaid to Reduce Human Immunodeficiency Virus Transmission in Houston, Texas: Insights From a Modeling Study.

"The authors declare no conflict of interest."

"The authors acknowledge the Houston Health Department’s NHBS team for data collection. The authors also acknowledge Carin Martin (Ryan White Grant Administration, Harris County Public Health) for her contributions to this study. In order to promptly disrupt onward transmission, Houston also continues to expand rapid initiation of ART. Just 1 of 15 grantees, a Houston community-based organization was awarded new federal funding in 2020 to build capacity for rapid ART implementation., The Houston jurisdiction’s Ryan White Grant Administration additionally scaled up rapid start as part of their Ending the HIV Epidemic initiative. Over the period of 2020–2021, they have provided over $3.7 million to initiate or enhance rapid start in 5 provider locations in the Houston area (personal communication, Carin Martin). There are several limitations in this study. The external transmission from Black MSM older than 34 years, women, and non-Black MSM were not included in the model. This is because of limited evidence that supports infections among YBMSM originating from these populations and high levels of racial homophily among Black MSM,, although results are somewhat mixed. Ongoing extensions to the model are expanding the representation of race/ethnicities, gender identities, and age groups included. Another limitation is that the target for a functional zero is not precisely defined yet. Research on a precise statistical definition of a functional zero is underway, and such a definition will help in planning better focused policy prescriptions. We also did not have data on the frequency of anal sex among YBMSM in Houston. We did, however, have comparable information for a similar population (younger Black MSM between 18 and 34 years of age) in Chicago. This frequency of anal sex produced calibration outcomes that were consistent with our Houston targets. Further research on estimating this parameter in Houston could help address this gap. In addition, our model does not take into account expanded coverage that may exist from local safety-net programs, such as financial assistance or sliding scale medical care through Federally Qualified Health Centers (FQHC) or Harris Health System’s Financial Assistance Program. This work was supported by National Institutes of Health NIH R01 DA 039934 to J.A.S., N.T.H., K.F. Additional support was provided by NIH R01AI136056 to J.A.S. and 1R56AI150272-01A1 to K.F. and J.A.S. A.S.K. was supported by the Providence/Boston Center for AIDS Research (P30AI042853) and Brown University’s Center for Addiction and Disease Risk Exacerbation (CADRE, P20GM130414). The authors acknowledge support from the Centers for Disease Control and Prevention (CDC) through Cooperative Agreements NU62PS924572 to M.M. and NU62PS005092 to S.K. Additional support for N.T.H. was provided by the Southern California HIV/AIDS Policy Research Center (H21PC3466) and the Center for HIV Identification, Prevention, and Treatment Services (P30 MH 058107). The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health, the Centers for Disease Control and Prevention, or the Department of Health and Human Services."