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The Participant-Reported Implementation Update and Score PRIUS: A Novel Method for Capturing Implementation-Related Data Over Time
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Evaluating statewide HIV preexposure prophylaxis implementation using All-Payer Claims Data.

Julia Raifman1, Kristen Nocka1, Omar Galárraga2

  • 1Department of Health, Law, and Policy, Boston University School of Public Health, Boston, MA.

Annals of Epidemiology
|April 14, 2020
PubMed
Summary
This summary is machine-generated.

All-Payer Claims Databases (APCDs) can track pre-exposure prophylaxis (PrEP) use for HIV prevention. While APCDs underestimated PrEP users, they show increased uptake and highlight the need for primary care provider prescribing, especially in underserved areas.

Keywords:
APCDAll-Payer Claims DatabasePrEPPrEP implementationPre-exposure prophylaxis

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Area of Science:

  • Public Health
  • Epidemiology
  • Health Services Research

Background:

  • Pre-exposure prophylaxis (PrEP) using daily emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) is effective in preventing HIV infection.
  • Systematic evaluation of PrEP uptake and usage has been a barrier to its widespread implementation.
  • All-Payer Claims Databases (APCDs) offer a potential solution for evaluating population-level PrEP implementation.

Purpose of the Study:

  • To assess the utility of APCDs for evaluating population-level PrEP implementation.
  • To describe PrEP implementation patterns in Rhode Island from 2012-2017.
  • To compare APCD data with other data sources for PrEP user identification.

Main Methods:

  • Utilized 2012-2017 data from Rhode Island's APCD.
  • Developed an algorithm to identify individuals prescribed FTC/TDF for PrEP.
  • Analyzed PrEP implementation by patient demographics, provider type, and geographic location (ZIP codes).
  • Compared APCD data against electronic medical record and comprehensive pharmaceutical claims data.

Main Results:

  • Rhode Island's APCD covered approximately 87% of the state's population.
  • PrEP use saw a 31-fold increase between 2012 and 2017.
  • PrEP users were primarily privately insured, male, and concentrated in Providence County.
  • Infectious disease providers were more likely to prescribe PrEP than primary care providers.
  • APCDs initially underestimated PrEP users but improved in accuracy over time.

Conclusions:

  • APCDs are a valuable resource for characterizing state-level PrEP utilization.
  • There is a critical need to enhance PrEP prescribing by primary care providers.
  • Targeted efforts are necessary to reach underserved populations and improve PrEP access.