State health policies and interest in PrEP: evidence from Google Trends

ABSTRACT

This study investigated the association between interest in Pre-exposure Prophylaxis (PrEP) in the US using Google Health Trends as a source of big data and state policy variables of Medicaid expansions under the Affordable Care Act (ACA) and initiation of PrEP Assistance Programs (PrEP-AP). As of December 2019, thirty-three states and the District of Columbia have accepted federal Medicaid funding provided through the ACA to expand eligibility to low-income adults. Among these expansion states, eight states also implemented PrEP-AP, a program that finances PrEP. A difference-in-differences approach estimated how changes in Google search for PrEP before and after the expansion differed across expansion and non-expansion states. Analyses also gauged whether the magnitude of the correlation between Medicaid expansions and Google searches was higher in states that also initiated PrEP-AP. Findings indicated that the Medicaid expansions were associated with a higher share of Google searches for PrEP keywords ($\text{β}=1.536$, S.E. =.36, $p<.001$). Moreover, the magnitude of correlation for some keywords was higher in states that also implemented PrEP-APs.

KEYWORDS:

• HIV
• pre-exposure Prophylaxis (PrEP)
• HIV prevention
• Google Trends
• Medicaid expansion

Acknowledgment

Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of NIH (grant number R01AI147487), the National Institute of Mental Health (grant number R01MH114847), and the National Institute on Drug Abuse (award number DP1 DA048570). The content is solely the responsibility of the authors and does not necessarily represent the official views of NIH. No financial disclosures or conflicts of interest were reported by the authors of this paper.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by National Institutes of Health: [Grant Number DP1 DA048570,R01AI147487-01,R01MH114847].