Evaluating HIV pre-exposure prophylaxis implementation using an all payers claims database

项目总结 艾滋病毒的流行继续不成比例地影响男男性行为者(MSM)和 美国的非裔美国人人口。暴露前预防(PrEP)已经证明 在高危人群中预防艾滋病毒感染的有效性。尽管疗效很高，PrEP的实施 在美国各地，评估实施情况并确定覆盖范围差距的方法一直很缓慢 都是有限的。这项研究的目标是评估和告知PrEP实施工作的一个新的 使用罗德岛所有付款人索赔数据库(APCD)的“大数据”方法。APCD是一种新兴的 包含来自Medicaid、Medicare和大多数(如果不是全部)私营保险公司的保险索赔的数据源。 罗德岛州是美国首批采用APCD的州之一。这项研究将开发和验证 使用RI APCD衡量PrEP摄取和持久性的算法(目标1)，描述PrEP实施 包括哪些医生开PrEP处方，以及PrEP患者的特征 规定(目标2)，并评估保险费用分担的影响(例如，自付、免赔额和 共同保险)关于PrEP摄取和持久性(目标3)。这项研究的结果将为以下工作提供基础 制定结构性干预措施，以促进高危人群和 告知与PrEP实施有关的州和联邦政策。

PROJECT SUMMARY The HIV epidemic continues to disproportionately impact men who have sex with men (MSM) and African American populations in the United States (US). Pre-exposure prophylaxis (PrEP) has demonstrated efficacy in preventing HIV acquisition among at-risk populations. Despite high efficacy, PrEP implementation across the US has been slow, and approaches to evaluate implementation and determine gaps in coverage have been limited. The goal of this study is to evaluate and inform PrEP implementation efforts with a novel “big data” approach using the Rhode Island All Payers Claims Database (APCD). APCDs are an emerging data source that contain insurance claims from Medicaid, Medicare, and most, if not all, private insurers. Rhode Island is one of the first states in the country to adopt an APCD. This study will develop and validate an algorithm to measure PrEP uptake and persistence using the RI APCD (Aim 1), describe PrEP implementation across the state including which physicians are prescribing PrEP and characteristics of the patients PrEP is being prescribed to (Aim 2), and assess the impact of insurance cost-sharing (e.g. co-pays, deductibles, and co-insurance) on PrEP uptake and persistence (Aim 3). Results of this study will provide the groundwork for the development of structural-level interventions to promote PrEP uptake among high-risk populations and inform state and federal policies pertaining to PrEP implementation.