PrEP Use Data
Current PrEP Algorithm:
An algorithm to differentiate the HIV treatment and HIV PrEP indications is built using prescription and diagnoses data for individuals taking Truvada (FTC/TDF) and its generic formulations (starting in 2020), Descovy (FTC/TAF) after its approval in 2019, or Apretude (cabotegravir) after its approval in 2021. For AIDSVu, the analyses determine total PrEP usage with FTC/TDF, FTC/TAF, or cabotegravir and not individually for each product.
The algorithm identifies and excludes individuals diagnosed with HIV or treated with other HIV agents, diagnosed with chronic Hepatitis B (CHB) or treated with CHB agents, or have post-exposure prophylaxis (PEP). The different categories for the indications are not mutually exclusive (for example, an individual may have both HIV and CHB). Individuals taking FTC/TDF, FTC/TAF, or cabotegravir are identified as taking PrEP if not eliminated due to diagnoses or treatment for HIV or CHB or have post-exposure prophylaxis (PEP) codes.
An individual with diagnosis or treatment codes for HIV, CHB or codes for PEP prior to the exposure era of FTC/TDF, FTC/TAF, or cabotegravir would be considered to not be taking PrEP.
Individuals who have monotherapy with FTC/TDF, FTC/TAF, or cabotegravir and ICD codes for HIV counseling (V6544, Z717) are classified as PrEP individuals.
The exclusion criteria in the algorithm includes the GPI codes that begin with 1210 (HIV specific antiretrovirals) and GPI codes that begin with 123520 (Hepatitis B specific agents). This list may vary with each database cut as new antiretrovirals and agents are added. The list should contain marketed products in the US, either individual agents or combination products. These lists will be updated annually.
Inclusion and Exclusion Criteria
Inclusion Criteria
The following are the study inclusion criteria:
- Individuals who have monotherapy with Truvada (FTC/TDF), including generic formulations, Descovy (FTC/TAF), or Apretude (cabotegravir)
Exclusion Criteria
The following are the study exclusion criteria:
- Individuals with HIV condition eras (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define HIV and opportunistic infections); or
- Individuals treated with other HIV agents (see Exclusionary Treatments for GPI codes that define HIV agents); or
- Individuals diagnosed with chronic Hepatitis B (CHB) (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define CHB); or
- Individuals treated with CHB agents (see Exclusionary Treatments for GPI codes that define CHB agents); or
- Individuals who have post-exposure prophylaxis (PEP) (see Exclusionary Conditions for a list of ICD-9/10-CM diagnoses codes that define PEP).
Codes and GPI Medication Codes Currently used in the PrEP Algorithm for Exclusionary Conditions and Exclusionary Treatments
Exclusionary Conditions
| Condition | Exclusion Items | ICD-9-CM Diagnoses Codes* | ICD-10-CM Diagnoses Codes* |
| HIV and opportunistic infections | HIV disease | 042 | B20 |
| Asymptomatic HIV infection | V08 | Z21 | |
| HIV-2 infection | 079.53 | B97.35 | |
| HIV complicating pregnancy | NA | O98.7X | |
| Nonspecific serologic evidence of HIV | 795.71 | R75 | |
| Candidiasis of bronchi, trachea, or esophagus | 112.84 | B37.81 | |
| Candidiasis of lungs | 112.4 | B37.1 | |
| Toxoplasmosis | 130.X | B58.X | |
| Coccidioidomycosis | 114.X | B38.X | |
| Cryptococcosis | 117.5 | B45.X | |
| Cryptosporidiosis | 007.4 | A07.2 | |
| CMV retinitis | 078.5 | B25.8 | |
| Kaposi’s sarcoma | 176.X | C46.X | |
| Mycobacterium avium complex | 031.2, 031.0 | A31.0, A31.2 | |
| Pneumocystis carinii pneumonia | 136.3 | B59 | |
| CHB | Chronic hepatitis B infection | 070.22, 070.23, 070.32, 070.33 | B18.1, B18.0 |
| PEP | Contaminated needle stick | E920.5 | W46.1X |
| Other specified prophylactic or treatment measure | V07.8 | Z29.89 | |
| Unspecified prophylactic or treatment measure | V07.9 | Z29.9 | |
| * ‘X’ denotes any letter(s) or number after the decimal point. | |||
Exclusionary Treatments
| Treatment | Exclusion Items | GPI Codes* |
| HIV treatment | Antiretrovirals | 1210xxx* (with the exception of Truvada [FTC/TDF], Descovy [FTC/TAF], and Apretude for PrEP) |
| CHB treatment | Hepatitis B agents (e.g., adefovir, entecavir, lamivudine, telbivudine, TAF) | 123520xxx*† |
| * ‘x’ denotes any number after the specified leading digits.
† The GPI code for Viread (TDF; 1210857010) is the same for the two approved HIV and HBV indications and is included within the HIV treatment era exclusions. |
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Faith-Based Organization Survey Data
Of those who responded to the demographic questions, survey results show that the majority of respondents were women (n=42, 58.3%), Black or African American (n=56, 78.8%), and non-Hispanic, Latino/a, or Spanish origin (n=60, 84.5%). The majority of respondents’ organizations were Christian (n=59, 68.6%), and 65.1% (n=82) of respondents were leaders of their faith communities. Of the faith leaders from non-Christian faith traditions, eight (9.3%) were Interfaith, three were Buddhist (3.5%), two were Muslim (2.3%), two were other (2.3%) and one practiced traditional African spirituality (1.2%). The majority of respondents were located in North Carolina (n=49, 43.8%), Georgia (n=13, 11.6%), Texas (n=10, 8.9%) and Florida (n=9, 8%) and represented nine Southern states. Respondents were also from the West, Midwest and East Coast. (See Table I for more details). Lastly, there was a diversity of respondents from politically and theologically conservative, centrist, and liberal organizations. Politically speaking, the majority (n=42, 55.4%) of respondents indicated that their organizations were “right in the middle,” with other respondents indicating their organizations were liberal (n=19, 25%) and conservative (n=15, 19.7%). Theologically speaking, the majority (n=37, 48.7%) of respondents indicated that their organizations were “right in the middle,” with other respondents indicating their organizations were liberal (n=24, 31.6%) and conservative (n=15, 19.7%).
The majority of faith leaders who completed the survey had personal connections to people living with or impacted by HIV/AIDS, such that 83.3% (n=135) of respondents personally knew someone who was living with HIV/AIDS, 71.4% (n=115) had made a home visit or a hospital visit to a patient living with HIV/AIDS, and 65.6% (n=105) had attended a funeral for a person who died from complications of AIDS. Twenty-eight (38.9%) respondents’ organizations had an HIV/AIDS ministry, 54 (73.0%) respondents were interested in receiving HIV/AIDS education for their organization, and 52 (74.3%) were interested in receiving HIV/AIDS testing for their organization.
In addition to having personal connections with people living with and/or were affected by HIV, we assessed respondents’ perceptions about how to address HIV stigma in Black faith communities. There were some respondents who expressed concern about potential negative treatment they might receive for discussing topics related to HIV, such as being perceived as gay if they talk about HIV/AIDS in a faith setting. (n=20, 8.9%). Others expressed concern that discussing reproductive health issues, including HIV/AIDS, may conflict with their faith tradition (n=30, 13.4%) and others expressed hesitation about implementing sexual education programs in their faith community (n=30, 20.3%). There were a minority of respondents (n=22, 14.9%) who also indicated that discussing HIV may negatively influence tithing and/or offering (financial or other) in their faith community/setting and may impact their faith community’s economic welfare (n=19, 12.8%).
Despite some expressing concerns about implementing HIV/AIDS programming and discussing issues related to HIV/AIDS, the majority of respondents expressed overwhelmingly positive attitudes about implementing HIV/AIDS programming. The majority of respondents (n=127, 56.7%) agree that faith leaders should get tested for HIV publicly to destigmatize and encourage widespread testing and the majority (n=176, 78.9%) agree that leaders should openly discuss HIV/AIDS with members of their faith community. Faith leaders can influence their faith communities by modeling health promotion behaviors such as HIV testing; being open and honest about HIV/AIDS in faith communities; and providing resources and support to people living with HIV/AIDS in faith communities.
The majority of respondents (n=59, 39.9%) indicated that their faith communities do not have the financial resources to host HIV/AIDS prevention programs as opposed to the 53 respondents (35.9%) who said they do have the necessary financial resources. This suggests that there is a need to address the financial and economic implications of discussing HIV in faith communities and the financial resources available for HIV/AIDS prevention programs in faith communities.
Despite not having financial resources to conduct HIV/AIDS programming, there are ways that faith leaders can promote HIV/AIDS awareness and health promotion behaviors. Faith leaders can play a key role in destigmatizing HIV/AIDS by getting tested for HIV publicly and talking openly about HIV/AIDS with their congregations. Faith communities can also provide resources and support to people living with HIV/AIDS.
