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.

Public Health Relevance

Although pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV, PrEP implementation efforts have been limited by effective approaches to evaluate uptake. All payers claims databases (APCDs) are emerging comprehensive databases of claims from Medicaid, Medicare, and private insurers. The goal of this study is to use the Rhode Island APCD to evaluate statewide PrEP implementation, and to assess the impact of cost-sharing (e.g. co-pays, deductibles, and co-insurance) on uptake and persistence.

Agency
National Institute of Health (NIH)
Institute
National Institute of Mental Health (NIMH)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21MH113431-02
Application #
9452114
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Brouwers, Pim
Project Start
2017-04-01
Project End
2019-03-31
Budget Start
2018-04-01
Budget End
2019-03-31
Support Year
2
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Miriam Hospital
Department
Type
DUNS #
063902704
City
Providence
State
RI
Country
United States
Zip Code
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