United States Inches Toward Eradicating Perinatal HIV, but Disparities Remain

By: Ranier Simons, ADAP Blog Guest Contributor

Despite the many advances in medical science, there is still no cure for HIV. In 2021, 38.4 million people were living with HIV. Approximately 36.7 million were adults, 1.7 million were children 15 years of age or younger, and 54% were women or girls.[1] There were 1.5 million new HIV infections globally as well.[1] These numbers are high, but all the data regarding HIV is not bad. While there is still a good deal of work to be done, perinatal HIV is nearly eradicated in the U.S. Perinatal HIV is HIV passed from mother to child during pregnancy, delivery, and childbirth, or through postpartum breastfeeding.[2]

Photo Source: HIV.gov

In 2012, the Centers for Disease Control & Prevention (CDC) published a framework for eradicating perinatal HIV in the United States. The framework contained a two-prong goal: reduce the incidence of perinatal HIV to fewer than 1 case per 100,000 live births and to reduce the transmission rate to less than 1 percent (less than 1 per 100 live births) in babies born to HIV-positive mothers. Using National HIV Surveillance System data, researchers recently published findings examining perinatal HIV information from 2010-2019. The number of live births to HIV-positive women decreased from 4587 in 2010 to 3525 in 2019, and the number of U.S. babies acquiring HIV perinatally reduced from 74 in 2010 to 32 in 2019.[3] These decreases equate to a perinatal HIV diagnosis rate decline of 1.9 to 0.9 per 100 000 live births and a perinatal HIV transmission rate decline from 1.6% to 0.9%.[3] For this time period, the CDC's two-pronged goal of the perinatal HIV elimination benchmark has been successfully reached. 

Although this is excellent news, the outcomes are not experienced among all demographics equitably. There are still disparities in racial and ethnic minority communities. Transmission rates in 2019 among Hispanics, Latinos, and those identifying as ‘other’ were between 1% and 2%. Also, the odds of reproductive age people living with undiagnosed HIV are higher among Black and Hispanic individuals.[4] Success in the reduction of perinatal HIV is the result of coordinated intersecting efforts of scientists, medical practitioners, policymakers, community groups, and even drug companies. However, it is essential to continue researching why some groups are still not being reached. There are individual and systemic barriers that are still resulting in perinatal HIV disparities.

Photo Source: Illinois Department of Public Health

Change is paramount in continued treatment development for pregnant HIV-positive women as well. More research needs to be performed to develop safer and even more effective antiretroviral treatment that benefits the mother and infant. The World Health Organization, International Maternal and Pediatric, and Adolescent Clinical Trials, and the International AIDS Society recently published proposed recommendations to include women much earlier in the pipeline of development of drugs for HIV prevention and treatment.[5] Developing medicines that are increasingly safe during conception, pregnancy, and lactation is crucial.

Moreover, continued efforts to improve culturally relevant and unbiased support of diverse groups of women will further promote complete perinatal HIV eradication in the United States. Annually, around 3,000-4,000 HIV-positive women deliver babies. Motherhood should be encouraged for all who desire it, and HIV-positive women should be supported in their reproductive choices.

[1] U.S. Department of Health and Human Services. (2022, August 21). Global Statistics. Retrieved from https://www.hiv.gov/hiv-basics/overview/data-and-trends/global-statistics/

[2] National Institutes of Health. (2023, January 1). Preventing Perinatal Transmission of HIV. Retrieved from https://hivinfo.nih.gov/understanding-hiv/fact-sheets/preventing-perinatal-transmission-hiv#:~:text=What%20is%20perinatal%20transmission%20of,to%2Dchild%20transmission%20of%20HIV

[3] Lampe, M., Nesheim, S., Oladapo, K>, Ewing, A., Wiener, J., Kourtis, A. (2023, April 18). Achieving elimination of perinatal HIV in the United States. Retrieved from https://publications.aap.org/pediatrics/article-abstract/doi/10.1542/peds.2022-059604/191071/Achieving-Elimination-of-Perinatal-HIV-in-the?redirectedFrom=fulltext. https://doi.org/10.1542/peds.2022-059604

[4] Centers for Disease Control and Prevention. HIV Surveillance Supplemental Report 2021. Estimated HIV Incidence and Prevalence in the United States, 2015–2019. Vol. 26. Atlanta, GA: Centers for Disease Control and Prevention; 2021

[5] Penazzato M, Lockman S, Colbers A, et al. Accelerating investigation of new HIV drugs in pregnancy: advancing the research agenda from theory to action. J Int AIDS Soc. 2022;25 Suppl 2(Suppl 2): e25912   

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Flawed Mifepristone Decision Threatens Public Health

By: Ranier Simons, ADAP Blog Guest Contributor

Ideological attacks on evidence-based established medical science through litigation continue to threaten the healthcare of millions. New legal challenges from anti-abortion groups restricting access to mifepristone join continued pushback from the Braidwood vs. Becerra decisions in the current news cycle. 

In November of 2022, an anti-abortion coalition of doctors called The Alliance for Hippocratic Medicine sued the U.S. Food and Drug Administration (FDA) stating that the agency improperly approved the drug mifepristone in September 2000. The group purports that the drug has serious safety issues that the FDA did not adequately consider. It claims the studies the FDA cites confirming the safety of mifepristone are flawed; thus, the drug should be taken off the market and approval revoked. Additionally, the group claims the FDA approved the drug using an accelerated process that was not thorough, thus abusing its authority.[1] 

Photo Source: Ohio Capital Journal

Mifepristone used in conjunction with misoprostol is the current established method of chemically inducing the termination of a pregnancy. Mifepristone is a steroid that starts the process and misoprostol makes the body expel the pregnancy tissue. Data has proven the duo to be the most effective with the least number of complications. Using misoprostol alone is not as effective and can result in complications that result in the need for surgical intervention to complete the abortion. It is safe to use misprostol alone with 93% of women using it alone having complete abortions without surgical assistance.[2] However, there are currently no official FDA backed protocols for using it alone.

Attorneys from the Alliance Defending Freedom represent the physicians. Alliance Defending Freedom is the same group that worked with Mississippi lawmakers on the suit at the center of the Dobbs v. Jackson Women’s Health Organization decision, which eventually overturned Roe V. Wade.[1] The group made efforts to get the case heard by Judge Matthew Kacsmaryk, of the U.S. Northern District of Texas, a judge Trump appointed in 2019.

The Amarillo division of the Northern District of Texas is a federal district with a single judge, Judge Kacsmaryk. The attorneys knew of his anti-abortion history, which is why they filed in his district. Judge Kacsmaryk has also issued rulings against protections for transgender persons and against asylum seekers forcing a return to Mexico while awaiting processing.[3] Moreover, Judge Kacsmaryk concealed from the Senate Judiciary Committee his authoring of an article titled “The Jurisprudence of the Body,” published in September 2017 in the Texas Review of Law and Politics.[4] In the article, he stated the Obama Administration had ignored the beliefs of religious physicians who “cannot use their scalpels to make female what God created male” and “cannot use their pens to prescribe or dispense abortifacient drugs designed to kill unborn children.”[4]

The case before Judge Kacsmaryk has not gone to trial yet. However, he held a hearing regarding the issue, whose results were released on April 7, 2023. He stated that the Alliance for Hippocratic Medicine had legal standing to sue, and that the FDA’s approval of mifepristone should be suspended nationwide while the case plays out in court. Additionally, he delayed the effective date of his ruling for a week to allow the Biden Administration to appeal.[1] The decision was appealed to the United States Court of Appeals for the Fifth Circuit, which ruled partially against Judge Kacsmaryk on April 12, 2023.

The appeals court ruled that Judge Kacsmaryk could not reverse the FDA’s 2000 approval of mifepristone because the statute of limitations for the plaintiffs to claim harm had passed. However, the three-person appeals panel added restrictions. The restrictions effectively reversed additional approvals for use the FDA issued in 2016 based on ongoing evidence-based research that had developed since its initial approval. The appeals court ruled that mifepristone should only be used up to 7 weeks of pregnancy, down from its current limit of 10 weeks. Additionally, it ruled that the drug could no longer be sent through the mail, it could only be obtained in person via three different doctor visits, and it could only be administered by a qualified physician instead of other medically qualified and licensed caregivers. The appeals court also invalidated the FDA’s 2019 approval of a mifepristone generic made by GenBioPro.

This ruling still greatly restricts mifepristone’s usage. It prevents pharmacies, both in-person and by mail, from dispensing the medication. Shortening the window in which the drug can be used reduces options for women depending on when they discover they are pregnant. The requirement of in-person doctor visits is one of the most significant hindrances. Requiring in-person doctor visits increases patients' costs of paying for multiple doctor visits, whether through insurance copay cost sharing or entirely out of pocket if uninsured. Additionally, it prohibits prescribing the drug through telehealth visits.

Photo Source: WHYY PBS | The Associated Press

In response to the appeal court’s ruling, the U.S. Department of Justice (DOJ) submitted an emergency consideration before the Supreme Court. As a result, on April 14, 2023, U.S. Supreme Court Justice Samuel Alito issued a temporary stay on all the lower court rulings. The temporary stay leaves mifepristone usage unchanged from the status quo until 11:59 PM Wednesday, April 19, 2023.[5] Both sides are instructed to submit responses so that the Supreme Court can ultimately rule if mifepristone can remain unencumbered while the appeal plays out or if the appeal court limits will be reinstated pending court trial.

U.S. Solicitor General Elizabeth Prelogar stated that “the lower court rulings are the first-time judges have repealed the conditions of an FDA drug approval based on a disagreement over the agency’s judgment about safety.”[5] Many pharmaceutical companies, patient advocacy groups, physicians, and government officials have been sounding the alarm concerning the danger of the initial case and its appeal. On April 14, 2023, 253 members of Congress (50 Senators and 203 Representatives) filed an amicus brief asking the Supreme Court to give relief from the district court ruling and the appellate ruling. 

They stated in the brief that “emergency relief from the order is necessary to mitigate the imminent harm facing members of the public, many of whom rely on the availability of mifepristone for reproductive care—and many more of whom rely on the integrity of FDA’s drug approval process for continued access to life-improving and life-saving drugs. Congress intended to—and did—vest authority in FDA to evaluate and ensure the safety and efficacy of drugs in the United States, and Amici call on this Court to give due weight to that intent.”[6]

A group of over 160 CEOs, healthcare organization presidents, and physicians also filed an amicus brief detailing the negative consequences of the ruling from an industry perspective.[7] In the brief, they explain several arguments against Judge Kacsmaryk’s and the appeals court ruling. The central idea is that the judge nor the court has the scientific or medical expertise to challenge the validity of the evidence behind the FDA. Mifepristone has been in use for over 20 years and has been extensively researched. The lower court rulings would also prevent the FDA from effectively using new data that comes from comparative safety data from real-world evidence. As drugs are used, continuous examination results in changes to initial use recommendations. The lower court rulings stifle the FDA’s ability to depart and evolve from a drug’s initial clinical trial findings. 

The legitimacy of the authority of the FDA is what is at stake. Rachel King, BIO's Interim President and CEO, stated: “We’ve repeatedly warned that the District Court’s decision would set a dangerous precedent for undermining the FDA, has consequences that extend well beyond the single drug, and stokes regulatory uncertainty in an industry responsible for bringing life-saving and life-enhancing therapies to vulnerable patient populations.”[8] 

Allowing ideology and special interest agendas to upend medical science threatens public health. It also threatens destabilization of the entire drug development infrastructure and investment. The results of the cases will have ripple effects regardless of the resolution.

[1] Kimball, S., Luhn, M., Mangan, D. (2023, April 7). Federal judge suspends FDA abortion pill approval, gives Biden administration time to appeal. Retrieved from https://www.cnbc.com/2023/04/07/federal-judge-stays-fda-abortion-pill-approval-gives-time-to-appeal.html

[2] University of California San Francisco. (2023, February 26). The recommended protocol for misoprostol-Only abortion. Retrieved from https://www.ansirh.org/research/research/recommended-protocol-misoprostol-only-abortion

[3] Kitchener, C., Marimow, A. (2023, February 25). The Texas judge who could take down the abortion pill. Retrieved from https://www.washingtonpost.com/politics/2023/02/25/texas-judge-abortion-pill-decision/

[4] Kitchener, C., Marimow, A., Barnes, R. (2023, April 15). The controversial article Texas federal judge Matthew Kacsmaryk did not disclose to the Senate. Retrieved from https://www.texastribune.org/2023/04/15/kacsmaryk-law-review-article-washington-post/

[5] Kimball, S. (2023, April 14). Supreme Court lifts abortion pill restrictions for now. Retrieved from https://www.cnbc.com/2023/04/14/supreme-court-temporarily-blocks-abortion-pill-restrictions.html

[6] Murray, P. (2023, April 14). Democrats in Congress File Amicus Brief Urging Supreme Court to Prevent Dangerous Ruling From Restricting Access to Mifepristone Nationwide & Upending FDA Approval Process. Retrieved from https://www.murray.senate.gov/democrats-in-congress-file-amicus-brief-urging-supreme-court-to-prevent-dangerous-ruling-from-restricting-access-to-mifepristone-nationwide-upending-fda-approval-process/[8

[7] Case 23-10362. (2023, April 11). Unopposed motion for leave to file brief of pharmaceutical companies, executives, and investors as amici curiae in support of appellants' motion for stay pending appeal. Retrieved from https://www.bio.org/sites/default/files/2023-04/2023-04-11-amicus-brief.pdf

[8] BIO. (2023, April 11). Press Release: BIO joins amicus brief challenging court's efforts to undermine FDA's authority to bring treatments and cures to patients. Retrieved from https://www.bio.org/press-release/bio-joins-amicus-brief-challenging-courts-efforts-undermine-fdas-authority-bring   

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

HIV, Depression, and Suicide

By: Ranier Simons, ADAP Blog Guest Contributor

In the early years of the HIV epidemic, a diagnosis was effectively a death sentence. There were no robust treatment regimens, and life expectancy was low. People suffered a great deal being overcome by opportunistic infections and lived in a great deal of isolation, whether in a hospital setting or at home. This resulted in a high prevalence of depression. Over the past few decades, medical advances in HIV treatment have transformed an HIV diagnosis into a manageable chronic health issue with people living long, healthy lives on antiretroviral therapy. But has mental health advances kept pace?

Photo Source: HIV.gov

Despite the advances, a high rate of depression and suicide remains among people living with HIV (PLWHA). Depression in PLWHA results in worsened disease states and poorer health outcomes. Data shows that depression can hasten the progression of AIDS, resulting in higher viral loads and lower CD4 counts.[1] Many PLWHA also have mental comorbidities that exacerbate their risk of suicide.[2] A recent study being presented at this year’s European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Copenhagen, Denmark (15–18 April), further examines depression and suicide in PLWHA.

The observational study utilized data from Denmark’s national health registers from 1995 -2021. The study compared 5,943 PLWHA with 59,430 sex and date-of-birth-matched controls from the general population. Researchers also investigated 5,807 siblings of PLWHA and 82,411 siblings of controls.[3,4] Overall, PLWHA had twice the risk of depression and treatment with electroconvulsive therapy, 1.5 times the risk of using antidepressants, and 3.5 times the risk for suicide.[3,4] These numbers were higher for the first two years after diagnosis. During this period, PLWHA had a threefold higher risk of depression and antidepressant use and a tenfold risk of suicide.[3,4] The study data also showed an increased risk of depression and suicide for the siblings of PLWHA compared to the general population, but it was not as high as the risk for PLWHA.

Photo Source: AIDSmap

This study was specific to Denmark. Other studies in the past, encompassing a global perspective, indicate that globally PLWHA have a 100 times higher risk of suicide than the general population.[5] Researchers agree that many more studies need to be conducted. The main weakness in the data from present and past studies is the variance. These observational studies try to normalize the data by comparing subjects to general population controls. However, past studies contain many differences in subject selection criteria. There are differences in cultural norms of the subjects, variance in types and availability of antiretroviral therapies or lack of them, and even societal factors that vary between continents.

What does not vary is the urgency of the need to address the mental health of PLWHA. Medical science has a focused, concerted effort to develop medications to treat and prevent. The same energy is needed to address psychological needs. Mental health screening of PLWHA must go hand in hand with treatment. PLWHA often have poor social support, face stigma, and don’t have access to trained mental health professionals.[2] Additional research also needs to thoroughly investigate issues such as long-term antiretroviral treatment's biological and cognitive effects or identifying pre-HIV infection mental comorbidities that may cause a higher incidence of depression and suicide once infected. 

Going forward, the mental health assessment and support of PLWHA must be on a continuum. It should start with psychological counseling and support when someone is about to be tested all the way through positive diagnosis, treatment, and long-term survival. Standardizing evidence-based mental health protocols for PLWHA will prevent suicides and improve the lives of PLWHA and their families and friends.

[1] Tran, B. X., Ho, R. C. M., Ho, C. S. H., Latkin, C. A., Phan, H. T., Ha, G. H., Vu, G. T., Ying, J., & Zhang, M. W. B. (2019). Depression among Patients with HIV/AIDS: Research Development and Effective Interventions (GAPRESEARCH). International journal of environmental research and public health, 16(10), 1772. https://doi.org/10.3390/ijerph16101772

[2] Liu, Y., Songtaweesin, W., Tucker, J., Sohn, A., Latkin, C., Hall, B. (2022). Suicide prevention research is crucial to achieving health equity for people with HIV. The Lancet HIV, 9(11),E745-E746, https://doi.org/10.1016/S2352-3018(22)00296-X

[3] American Association for the Advancement of Science. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide, especially in first 2 years after diagnosis. Retrieved from https://www.eurekalert.org/news-releases/984677#.ZC75j2xKVyk.twitter

4) Medical Express. (2023, April 3). People living with HIV at substantially higher risk of depression and suicide. Retrieved from https://medicalxpress.com/news/2023-04-people-hiv-substantially-higher-depression.html

5) Pelton, M., Ciarletta, M., Wisnousky, H., et al. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. General Psychiatry 2021;34:e100247. doi: 10.1136/gpsych-2020-100247

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.  

Culture War Against ACA Scores Win

By: Ranier Simons, ADAP Blog Guest Contributor

March 23, 2023, was the 13th anniversary of the signing of the Affordable Care Act (ACA). The landmark legislation forever changed the landscape for healthcare insurance and healthcare access in the United States. About 35 million people presently have ACA-related healthcare coverage, with 21 million of those enrolled in Medicaid expansion coverage.[1] The law enabled many to obtain robust healthcare coverage who were previously uninsured or underinsured. Most importantly, while not perfect, the ACA is an effective tool to support equity in healthcare coverage and treatment. Through the ACA, participants receive comprehensive and affordable care regardless of their income or lack of.

Unfortunately, from its inception to the present day, there have been political battles over the ACA that are ideological instead of evidence-based. Politicians, judges, and media personalities continually attempt to dismantle the ACA without having the plan to replace it. Opponents of the law have found an ally in Judge Reed O’Connor, a federal judge in Texas. In 2018, Judge O’Connor ruled that the entire ACA was unconstitutional. The Supreme Court eventually defeated the ruling. Judge O’Connor has previously made rulings against the ACA’s non-discrimination provisions, contraceptive coverage requirement, and regulation of insurance provider fees in states.[2]

Photo Source: Law.com

Judge O’Connor’s latest challenge to the ACA is in Braidwood Management Inc. v. Becerra. In this case, six individuals and Christian-owned businesses claim that private health insurance coverage requirements are unconstitutional. Additionally, they argue that being required to provide coverage for PrEP under their insurance plans violates their religious beliefs and thus violates the Religious Freedom Restoration Act (RFRA).[3]

The ACA requires insurers to cover certain preventative care services without any cost-sharing by the insured. Those services will be provided for free when obtained through a provider in an insurance plan’s network. The ACA uses guidance from the United States Preventative Task Force (USPSTF) to determine the aforementioned services. The USPSTF was created in 1984 by the U.S. Public Health Service Act to improve public health through evidence-based recommendations to prevent disease and increase life expectancy.[4] Sixteen national experts on preventative medicine and primary care comprise the USPSTF. They make their recommendations based on scientific evidence with no conflicts of interest or political influence.

Photo Source: Axios

In September 2022, Judge O’Connor ruled that the USPSTF violates the Appointments Clause because the members are not appointed by the President and subsequently confirmed by the Senate; nor are their recommendations reviewed by Constitutionally specified officials. Thus, he decided that the Braidwood Management plaintiffs should not be required to pay for conventional medical insurance plans that mandate coverage of preventative services recommended by the USPSTF because the entity and its recommendations are unconstitutional. Judge O’Connor further ruled that the PrEP coverage mandate violated Braidwood’s religious freedom rights under the RFRA. Braidwood argued that paying for coverage that included provisions for PrEP made them implicit in supporting homosexuality, drug use, and sex between a man and a woman outside of marriage. At the time of the initial ruling, legal remedies had not been specified, and both sides were instructed to present briefs relating to the scope of relief. Moreover, the initial focus was explicitly on Braidwood being required to pay for plans that provided PrEP without cost sharing and the non-religious plantiffs not being required to pay for preventative services such as contraception and std testing.

March 30, 2022, Judge O’Connor ruled on the case's legal remedy. He invalidated the ACA's HIV treatment mandate of providing PrEP, stating it violated Christian employers' rights under the RFRA. Thus, the government could not take any legal action requiring the Braidwood parties and religious objectors to pay for PrEP. He went a step further, stating that any recommendations for preventative services made by the USPSTF on or after March 30, 2010, are unlawful. Effectively, this is a national block meaning insurance plans no longer must cover many preventative services for free. These services include biennial mammography screening for women aged 50-74, cervical cancer screening in women aged 21-65, colorectal cancer screening in adults aged 45-49, and PrEP. The complete list of these services is here. 

Without coverage for PrEP, it is estimated that over 2000 preventable HIV infections will occur within a year.[7] For every 10% decrease in PrEP coverage, there would be an additional 1,140 HIV infections among MSM the following year. Generic PrEP costs $30 per month, and brand-name products that don’t have generic versions can cost over $20K annually. Additionally, there are lab work and provider visits associated with the administration of PrEP. Those expenses are around two thousand dollars a year. Blocking the HIV treatment mandate would result in cost-sharing or complete denial of coverage resulting in out-of-pocket costs that those needing help cannot afford.

Photo Source: NPR

Blocking the coverage mandate for other preventative services would also have dire consequences. Lack of certain screenings means that many conditions, including cancers, will go undiscovered until late stages. This would result in many preventable diseases, decreased healthcare outcomes, including death, and increased medical costs. Such a future is in opposition to the Institute for Healthcare Improvement’s “Triple Aim”: improving the individual experience of care, improving the health of populations, and reducing the per capita costs of care for populations.[8]

Judge O’Connor’s ruling is not the final law. There will be appeals, and it could reach the Supreme Court. Presently in 2023, no plans are affected since the current coverages are in place via the contracts policyholders have with their insurance companies. Additionally, it is possible a hold will be placed on the order as it makes its way through the courts. The American College of Obstetricians and Gynecologists, in a statement, said: "Allowing personal or political bias to interfere with the practice of medicine will cause harm to our patients."[6] Unfortunately, recent policy decisions in Tennessee, New York, and now Texas seem to be setting up the harm the American College of Obstetricians and Gynecologists warns against.

[1] U.S. Department of Health and Human Services. (2022, April 29). New Reports Show Record 35 Million People Enrolled in Coverage Related to the Affordable Care Act, with Historic 21 Million People Enrolled in Medicaid Expansion Coverage. Retrieved from https://www.hhs.gov/about/news/2022/04/29/new-reports-show-record-35-million-people-enrolled-in-coverage-related-to-the-affordable-care-act.html

[2] Sneed,T. (2022, January 28). Judge notorious for anti-Obamacare rulings has another crack. Retrieved from https://www.cnn.com/2022/01/28/politics/obamacare-reed-oconnor-biden-doj-health/index.html

[3] Sobel, L., Ranji, U., Pestaina, K., Dawson, L., Cubanski, J. (2022, October 26). Explaining Litigation Challenging the ACA’s Preventive Services Requirements: Braidwood Management Inc. v. Becerra. Retrieved from https://www.kff.org/womens-health-policy/issue-brief/explaining-litigation-challenging-the-acas-preventive-services-requirements-braidwood-management-inc-v-becerra/

4) USPSTF. (2021). USPSTF: An Overview. Retrieved from https://www.uspreventiveservicestaskforce.org/uspstf/about-uspstf/task-force-resources/uspstf-overview#:~:text=The%20U.S.%20Preventive%20Services%20Task,prevent%20disease%20and%20prolong%20life.

5) Braidwood v. Becerra, 2022,  https://storage.courtlistener.com/recap/gov.uscourts.txnd.330381/gov.uscourts.txnd.330381.92.0_2.pdf

6) Pierson, B. (2023, March 30). U.S. judge blocks Obamacare coverage mandate for some cancer screenings, PrEP. Retrieved from https://www.reuters.com/business/healthcare-pharmaceuticals/texas-judge-blocks-obamacare-coverage-mandate-prep-cancer-screening-2023-03-30/

7) Klein, H. (2023, March 29). PrEP court ruling could lead to thousands of preventable HIV cases. Retrieved from https://www.ajmc.com/view/prep-court-ruling-could-lead-to-thousands-of-preventable-hiv-cases

8) IHI.(2023) The IHI Triple Aim. Retrieved fromhttps://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx   

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.