Evaluating statewide HIV pre-exposure prophylaxis implementation using All Payer Claims Data

Abstract Introduction Pre-exposure prophylaxis (PrEP) in the form of daily emtricitabine and tenofovir disoproxil fumarate (FTC/TDF) is effective for preventing HIV infection. Implementation has been limited by an inability to systematically evaluate uptake and use. All payer claims databases (APCDs) provide an opportunity to evaluate population-level PrEP implementation. Materials and Methods We used 2012-2017 data from Rhode Island’s APCD and developed an algorithm to identify individuals prescribed FTC/TDF for PrEP. We describe PrEP implementation by patient demographics and provider type, and mapped PrEP implementation across ZIP codes. We compared APCD data to electronic medical record (EMR) data and comprehensive pharmaceutical claims data ( AIDSVu.org ). Results The Rhode Island APCD represented approximately 87% of the state’s population. PrEP use increased 31-fold from 2012-2017. Users were predominantly privately insured, male, and concentrated in Providence County (76.6%). Infectious diseases providers had 3.2 times the odds of being a PrEP prescriber compared to primary care providers. Compared to other pharmaceutical and EMR data, the APCD underestimated the number of PrEP users in Rhode Island but improved in capturing users over time. Conclusions APCDs are a useful data source for characterizing PrEP use across a state. There is a need to increase PrEP prescribing among primary care providers, especially in areas with underserved populations.