Changes in health care coverage and sexually transmitted infection testing following expansion of health care coverage options among people with diagnosed HIV - Medical Monitoring Project, Virginia, 2015-2022.

Health care coverage is key for health among people with HIV (PWH). We assessed differences in health care coverage and HIV outcomes and sexually transmitted infection (STI) testing between pre- and post-Medicaid expansion periods among PWH in Virginia. We analyzed Virginia's CDC Medical Monitoring Project data for 2015-2022 (N = 1169). Weighted percentages were assessed for characteristics. Differences in characteristics and outcomes between the pre-expansion (2015-2018) and post-expansion (2020-2022) were assessed using prevalence differences (PDs) and 95% CIs with predicted marginal means; data from 2019 were excluded as the transition year. The number of PWH covered by Medicaid was higher post- than pre-expansion (30.1%-33.9% vs. 18.9%-25.4%). Overall, the percentage of PWH missing ≥1 antiretroviral therapy (ART) dose in the past 30 days was 37.6% in pre- and 29.9% in post-expansion (PD: -7.7; 95% CI: -14.4-1.1). Rates of testing for gonorrhea, chlamydia, and syphilis during the past 12 months were higher in post- than pre-expansion (34.8% vs. 27.8%; PD: 6.9; 95% CI: 0.5-13.3). Medicaid coverage increases among PWH following expansion were associated with increases in ART adherence and STI testing. Expanding health care coverage options that decrease cost barriers may support ART adherence and STI screening among PWH.