Claims-Based Algorithm to Identify Pre-Exposure Prophylaxis Indications for Tenofovir Disoproxil Fumarate and Emtricitabine Prescriptions (2012-2014): Validation Study

• Published in: JMIR formative research Vol. 8; p. e55614
• Main Authors: Sullivan, Patrick Sean, Mera-Giler, Robertino M, Bush, Staci, Shvachko, Valentina, Sarkodie, Eleanor, O'Farrell, Daniel, Dubose, Stephanie, Magnuson, David
• Format: Journal Article
• Language: English
• Published: Canada JMIR Publications 04.11.2024
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Algorithms; Anti-HIV Agents - administration & dosage; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Asymptomatic; Codes; Disease prevention; Drug Prescriptions - statistics & numerical data; Emtricitabine - administration & dosage; Emtricitabine - therapeutic use; Female; Generic products; Health surveillance; Hepatitis B; HIV; HIV Infections - drug therapy; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infectious diseases; Male; Medical records; Middle Aged; Original Paper; Patients; Pre-Exposure Prophylaxis - methods; Prescription drugs; Sexual health; Tenofovir - administration & dosage; Tenofovir - therapeutic use; Validation studies; United States > US; electronic medical record; pharmaceutical; pre-exposure prophylaxis; medication; EMR; PrEP; classification; EHR; drug; HIV; pharmacotherapy; monotherapy; pharmacology; electronic health record; prevention; algorithm
• ISSN: 2561-326X; 2561-326X
• DOI: 10.2196/55614

To monitor the use of tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and related medicines for pre-exposure prophylaxis (PrEP) as HIV prevention using commercial pharmacy data, it is necessary to determine whether TDF/FTC prescriptions are used for PrEP or for some other clinical indication. This study aimed to validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. An algorithm was developed to identify whether TDF/FTC prescriptions were for PrEP or for other indications from large-scale administrative databases. The algorithm identifies TDF/FTC prescriptions and then excludes patients with International Classification of Diseases (ICD)-9 diagnostic codes, medications, or procedures that suggest indications other than for PrEP (eg, documentation of HIV infection, chronic hepatitis B, or use of TDF/FTC for postexposure prophylaxis). For evaluation, we collected data by clinician assessment of medical records for patients with TDF/FTC prescriptions and compared the assessed indication identified by the clinician review with the assessed indication identified by the algorithm. The algorithm was then applied and evaluated in a large, urban, community-based sexual health clinic. The PrEP algorithm demonstrated high sensitivity and moderate specificity (99.6% and 49.6%) in the electronic medical record database and high sensitivity and specificity (99% and 87%) in data from the urban community health clinic. The PrEP algorithm classified the indication for PrEP in most patients treated with TDF/FTC with sufficient accuracy to be useful for surveillance purposes. The methods described can serve as a basis for developing a robust and evolving case definition for antiretroviral prescriptions for HIV prevention purposes.