@Article{info:doi/10.2196/55614,
author="Sullivan, Patrick Sean
and Mera-Giler, Robertino M
and Bush, Staci
and Shvachko, Valentina
and Sarkodie, Eleanor
and O'Farrell, Daniel
and Dubose, Stephanie
and Magnuson, David",
title="Claims-Based Algorithm to Identify Pre-Exposure Prophylaxis Indications for Tenofovir Disoproxil Fumarate and Emtricitabine Prescriptions (2012-2014): Validation Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="4",
volume="8",
pages="e55614",
keywords="pre-exposure prophylaxis; PrEP; classification; electronic medical record; EMR; algorithm; electronic health record; EHR; drug; pharmacology; pharmacotherapy; pharmaceutical; medication; monotherapy; HIV; prevention",
abstract="Background: 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. Objective: This study aimed to validate an algorithm to distinguish the use of TDF/FTC for HIV prevention or infectious disease treatment. Methods: 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. Results: 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. Conclusions: 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. ",
issn="2561-326X",
doi="10.2196/55614",
url="https://formative.jmir.org/2024/1/e55614",
url="https://doi.org/10.2196/55614",
url="http://www.ncbi.nlm.nih.gov/pubmed/39141024"
}