Medicaid in Arizona adds HIV prevention drug to approved list starting Oct. 1

Officials with Arizona's Medicaid program on Wednesday announced plans for wider use of the drug PrEP to help reduce one of the highest rates of new HIV infections in the country.

In a joint announcement with U.S. Centers for Disease Control and Prevention director Dr. Robert Redfield, officials with the Arizona Health Care Cost Containment System said they'd be promoting more availability of Truvada for PrEP (pre-exposure prophylaxis) as a way of preventing new HIV infections in people who are currently HIV negative but at risk for contracting the virus.

"We have a once-in-a-generation opportunity to bring an end to the AIDS epidemic," Redfield said. "Over 700,000 people in our country have died from HIV infection and we get about 40,000 new infections per year, which have continued really without any change without the six, seven or eight years."

With no change, that could mean 400,000 more Americans will have HIV infection in 10 years.

Maricopa County an HIV hotspot

Maricopa County is one of 50 jurisdictions in the country identified for its high rates of new HIV infections, which is what brought Redfield to Phoenix this week. There were 768 new diagnoses of HIV in Arizona in 2017 — the most recent state data available.

Most of those infections were in Maricopa County.

"One of the reasons I'm here is that you are one of those jurisdictions," Redfield said. "The Southwest U.S. has a number of these jurisdictions. ... The one area this nation has not had a significant reduction in transmission is the Latino population."

A national initiative introduced in President Donald Trump's State of the Union address this year aims to reduce new HIV infections by 75% in the next five years and by 90% in the next 10 years.

Starting on Oct. 1, PrEP will be added to the AHCCCS list of approved drugs that do not require preauthorization, said Dr. Eric Tack who is the agency's interim clinical administrator. Of the 1.8 million people enrolled in AHCCCS, which is a government health insurance program for low income people, about 1,300 are estimated to be in the high-risk group that would likely receive PrEP, Tack said. 

Preventing HIV is more cost-effective than treating patients once they have acquired the disease, Tack said.

"This is huge and it's long overdue. It's a huge step in the right direction," said Dr. Christoper Labban, a local physician who is president of the Arizona Osteopathic Medical Association, reacting to the news.

"It is a big deal and it is absolutely an improvement," said Rocko Cook, outreach manager for the Southwest Center in Phoenix, which serves individuals affected by HIV/AIDS. "So many people do not have the ability to go on PrEP."

PrEP awareness still too low

Daily PrEP reduces the risk of getting HIV from sex by more than 90%, the CDC says. Among people who inject drugs, it reduces the risk by more than 70%. The risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other prevention methods, federal officials say.

African American and Latino men who have sex with men and are between the ages of 25 and 34 are disproportionately affected when it comes to new HIV infections nationwide, Redfield said. Public health officials need to figure out how to get the prevention message to that population, he said.

"When we looked across the U.S. to see where HIV was occurring, we noticed that actually over 50% of the new diagnoses of HIV occurred in only 50 jurisdictions," Redfield said, noting that the Phoenix area is one of those areas.

"It's very important that we realize our current efforts to treat and prevent HIV prevention, while they worked in many different areas, they haven't reached other people," he said. "... I think people don't realize that there really are very good biological mechanisms to prevent HIV."

Labban said it is important to not just focus on the high-risk populations. He recently treated a heterosexual woman in her 30s who tested positive for HIV. It turned out she'd been in a relationship with a man who was engaging in high-risk behavior.

He said PrEP needs to be available to people who are not on AHCCCS and don't have insurance.

"We need to be able to reach out to them and educate them that this is available," he said. 

Redfield said he wants local health officials to develop their own strategies to increase diagnoses, treatment and embrace evidence-based prevent strategies — most importantly, PrEP.

About 1.2 million to 1.6 million Americans right now who are vulnerable to acquiring HIV and less than 30% of them have chosen to get PrEP, which shows there's still a long way to go, he said.

"It's really important that everybody knows their HIV status. Everybody has an HIV status, and hopefully you know yours," Arizona Department of Health Services Director Dr. Cara Christ said. "If you don't, please go get tested."

The most recent state data shows approximately 18,000 Arizonans are living with HIV/AIDS, but approximately 16% of them don't know they are HIV positive.

Christ said future strategies to combat HIV infections include social media campaigns promoting PrEP, establishing mobile HIV testing units, expanding testing hours and expanding the number of providers offering opt-out HIV testing.

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes.

Support local journalism. Subscribe to azcentral.com today.