Paying for PrEP: A qualitative study of cost factors that impact pre-exposure prophylaxis uptake in the US.

BACKGROUND: Concerns about the actual and perceived costs of pre-exposure prophylaxis (PrEP) continue to be a major barrier to uptake among gay, bisexual and men who have sex with men (GBMSM) in the United States. METHODS: We conducted semi-structured interviews with 25 GBMSM who presented for routine health care at a STD clinic in the northeastern United States. The cohort included GBMSM who were or were not currently taking PrEP and represented varied health care coverage and financial resources. We used a structured coding scheme to analyze transcripts and identify themes relevant to cost factors. RESULTS: Participants shared their perspectives about PrEP and their experiences with accessing and paying for PrEP. Our findings suggest that health care coverage or financial assistance were essential to PrEP access but were not easily accessible to all people and did not always cover all costs. Therefore, paying for PrEP had to be balanced with other life expenses. Participants had multiple sources for information about PrEP cost and assistance from clinic and pharmacy staff helped reduce burden and resolve difficulties. CONCLUSION: Addressing gaps in health care coverage, providing financial support, and improving the enrollment process in a financial assistance program may improve PrEP uptake.

A database of US state policies to mitigate COVID-19 and its economic consequences.

BACKGROUND: Since COVID-19 first appeared in the United States (US) in January 2020, US states have pursued a wide range of policies to mitigate the spread of the virus and its economic ramifications. Without unified federal guidance, states have been the front lines of the policy response. MAIN TEXT: We created the COVID-19 US State Policy (CUSP) database ( https://statepolicies.com/ ) to document the dates and components of economic relief and public health measures issued at the state level in response to the COVID-19 pandemic. Documented interventions included school and business closures, face mask mandates, directives on vaccine eligibility, eviction moratoria, and expanded unemployment insurance benefits. By providing continually updated information, CUSP was designed to inform rapid-response, policy-relevant research in the context of the COVID-19 pandemic and has been widely used to investigate the impact of state policies on population health and health equity. This paper introduces the CUSP database and highlights how it is already informing the COVID-19 pandemic response in the US. CONCLUSION: CUSP is the most comprehensive publicly available policy database of health, social, and economic policies in response to the COVID-19 pandemic in the US. CUSP documents widespread variation in state policy decisions and implementation dates across the US and serves as a freely available and valuable resource to policymakers and researchers.

Primary Care for Transgender Adolescents and Young Adults in Rhode Island: An Analysis of the all Payers Claims Database.

PURPOSE: Structural stigma has shaped disparities across several domains of health for transgender relative to cisgender (nontransgender) adolescents in the United States. Research on transgender health has largely overlooked the role of preventive care, especially for adolescents. METHODS: We used ICD-9 and ICD-10 codes to identify transgender adolescents in the Rhode Island All Payers Claims Database (APCD) from 2011 to 2017 based on a diagnosis for gender identity disorder (GID). We evaluated differences in the use of preventive care services between transgender and cisgender adolescents. We compared the frequency of sexually transmitted infection and HIV screening and the percentage prescribed pre-exposure prophylaxis among transgender and cisgender adolescents using t-tests and chi-square tests. We used logistic regression to evaluate the association between attending regular physical exams and receiving preventive health services. RESULTS: There was no significant difference in the proportion of transgender and cisgender adolescents who received regular influenza vaccinations, physical exams, and HPV vaccinations. Transgender adolescents were significantly more likely to receive regular cholesterol and BMI screenings compared to cisgender adolescents. While there was a significant positive association between having regular physical exams and receiving most preventive screenings in the cisgender population, in the transgender population, regular physical exams were only significantly positively associated with STI screening. CONCLUSIONS: Transgender adolescents accessing the healthcare system received similar, if not greater, levels of preventive health services compared to their cisgender peers. Because regular physical exams were not associated with receiving most preventive services among transgender adolescents, these services may be delivered outside of primary care settings.

Evaluating statewide HIV preexposure prophylaxis implementation using All-Payer Claims Data.

PURPOSE: Preexposure 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. 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 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 to 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 electronic medical record 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.