Mississippians in underserved areas now have access to subsidized HIV-prevention services, including prophylactic treatment, from a distance. The expansion is a result of a Mississippi State Department of Health partnership with Crossroads Clinic in the Jackson Medical Mall. Combined with promising but underused Medicaid programs, the initiative has the potential to drive down the state’s critically high HIV and other STD rates.

State Health Officer Dr. Thomas Dobbs stressed the value of preventative intervention in an April 9 interview with the Crirec.

“We’ve known for years that Mississippi and the rural South have been a hotbed for transmission of HIV,” Dobbs said, “But we also have great tools available to us.”

Mississippians can call 601-432-3066 to schedule a telemedicine appointment with the new program.

A Vastly Underutilized Tool

Dobbs refers to two pills: pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is a prescription medicine, taken once daily, that reduces the likelihood of acquiring HIV through sex by 99%, and through intravenous drug use by at least 74%. PEP is an emergency medicine made for those potentially exposed to HIV for use within 72 hours of exposure.

Both pills, taken properly, are extremely effective at preventing HIV. But they are prescription medicines, requiring a doctor’s visit and, for many who cannot afford steep out-of-pocket costs, subsidized payment before they can be used.

“It’s highly effective against HIV infection, but it’s vastly underutilized,” Dobbs said. “Often people don’t live close to places where these services are available. It’s a perfect mix for telemedicine.”

PrEP An Essential Tool to end HIV
PrEP and PEP have shown extreme effectiveness at preventing HIV infections when used properly—both before and after exposure to the virus, respectively. Graphic courtesy CDC

PrEP in particular requires a negative HIV test to begin, which is where MSDH comes into play. Dobbs explained that all necessary labs for the process are available at the county health departments scattered across the state.

Video and voice chat allows for clinicians located in Jackson to handle the educational and diagnostic elements of the process for Mississippians without an in-person visit. “It’s truly the right thing to do,” Dobbs explained. “It’s something we’ve been working on for a while, and we’re super excited to have it operational.”

Free Clinical Visits

MSDH announced the new program this week, and Dobbs stressed that all residents could take advantage of no-cost assessments, and for many—even those who do not otherwise qualify for Medicaid—free medication and contraceptives as well.

“(Mississippians) can expect to have a free clinical visit. It’s free of charge for us to assess them.” Dobbs said. On the medicine side, “there are a couple of different mechanisms to get free meds to folks.”

Most notably, Dobbs highlighted the Mississippi Division of Medicaid Family Planning Waiver, another under-used program that he said could provide no-cost STD prevention or treatment to residents who would not otherwise qualify for Medicaid.

“It’s basically a limited benefit for people of reproductive age … and it pays for PrEP,” Dobbs said. PrEP—listed here as Truvada—is only one of dozens of STD medications covered through the Medicaid Family Planning Waiver, in addition to many forms of contraceptives.

Mississippians under 45, without other health insurance and earning up to 194% of the federal poverty level (around $25,000 for a single adult) can take advantage of the partial Medicaid benefits included in the waiver.

Blue PrEP pills
PrEP is an extremely effective preventative measure against HIV infection, but its cost prevents many from using it effectively. Dr. Thomas Dobbs hopes that MSDH’s new partnership can help extend subsidized access to the drug to needy communities. Photo courtesy CDC

MSDH hopes that a combination of increased access through telehealth and subsidized care through specific Medicaid waivers, which telehealth providers can help patients access, will address the gaping health disparities in rural, impoverished and minority communities around the state.

HIV is highly prevalent in Mississippi. The state is seventh in the nation for rates of HIV diagnosis, and that rate is tremendously higher in some of the state’s biggest health-care deserts. In 2019, MPB reported that HIV rates in the Mississippi Delta outpaced the national average by over 60%. Young adults between 20 and 29 are the source of most new cases of HIV.

Rural areas are not the only ones hard hit by the crisis. In 2016, the CDC found Jackson to have the sixth-highest rate of HIV diagnosis of any city in America. That soaring rate of infection is symptomatic of the racial disparities inherent in the spread of the virus. NPR reported CDC data showing that, if current rates persist, half of all Black men who sleep with men will eventually be diagnosed with HIV.

For other STDs, Mississippi’s comparative rates are even higher. Mississippi is first in the nation for gonorrhea and third in the nation for both chlamydia and syphilis. Telehealth intervention can address all of these diseases through preventative and curative measures.

Telehealth Expansion Died in Legislature

The COVID-19 pandemic provided a key opportunity for expanding access to telehealth services in the state, both out of necessity and through federal government intervention.

“We’ve been forced to (adapt), because we need to be safe. A lot of physicians in clinics have really figured out how to do it, and where it’s most appropriate.”

Emergency measures during the pandemic have expanded Medicaid access to numerous forms of telehealth. Providers of all kinds could bill Medicaid for telehealth treatments as though they were in-person care. Those opportunities will expire with the pandemic.

“There was a bill in the Legislature that would have perpetuated those insurance benefits,” Dobbs said. “But it didn’t make it through.”

Rep. Robert Johnson III, D-Natchez, introduced a telehealth bill that would have permanently enshrined telehealth coverage in Medicaid for federally qualified health centers and community health centers, medical clinics that provide no-cost treatment to some of the state’s most vulnerable populations.

Like the postpartum Medicaid extension, reticence on the part of Republican legislators to even breathe upon Medicaid expansion spelled doom for the bill, which quickly died in committee.

A coming end to affordable telehealth coverage for many Mississippians only highlights the importance of MSDH’s new partnership. Dobbs acknowledged that access to care issues deeply complicated the department’s core mission, but shared a willingness to pursue solutions to the state’s health disparities through the end of the pandemic and beyond.

The state health officer summed up the momentum that MSDH hoped to harness coming out of the pandemic. “Lowering the barriers is so important, and we’ve been working towards this for years. There’s a whole host of things that are perfectly aligned—high value targets for public health intervention that we can build on. (We’ve had) a quantum leap in telemedicine as a country,” Dobbs finished.

“I hope we don’t turn it back.”

Nick Judin began his career in journalism at the Jackson Free Press in 2019, coming on as State Reporter to cover the 2020 legislative session. That posting quickly gave way to a year leading the JFP’s COVID-19 coverage. Nick’s reports from the frontline of coronavirus have repeatedly made national headlines, as he has asked hard questions of state leadership and done critical interviews with the state’s top public-health experts. Email the Jackson, Miss., native at [email protected] and follow him on Twitter at @nickjudin.