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

项目摘要 艾滋病毒流行病继续对男男性行为者（MSM）造成不成比例的影响， 美国的非洲裔美国人（US）。暴露前预防（PrEP）已经证明 预防高危人群感染艾滋病毒的有效性。尽管疗效高，PrEP实施 整个美国的进展缓慢，评估实施情况和确定覆盖范围差距的方法 都是有限的。本研究的目标是评估和告知PrEP实施工作与一种新的 使用罗得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）私人保险公司的保险索赔的数据源。 罗得岛是美国最早采用APCD的州之一。这项研究将开发和验证一个 使用RI APCD测量PrEP摄取和持续性的算法（目标1），描述PrEP实施 在整个国家，包括医生处方PrEP和患者的特点PrEP是 （目标2），并评估保险费用分摊的影响（如共同支付，免赔额， 共同保险）的PrEP吸收和持久性（目标3）。这项研究的结果将为以下方面奠定基础： 制定结构性干预措施，促进高危人群接受PrEP， 告知州和联邦有关PrEP实施政策。

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.