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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.

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.

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.

BackgroundPre-exposure prophylaxis (PrEP) in the form of daily tenofovir disoproxil fumarate (TDF/FTC) is a potentially transformative tool to prevent HIV infection. However, PrEP scale-up in the United States has been slow and difficult to evaluate comprehensively. All payer claims databases (APCDs) are large datasets that contain information on medical and pharmaceutical claims from most public and private payers in each state, and provide an unusual opportunity to evaluate statewide PrEP implementation efforts.MethodsWe used 2012–2017 data from Rhode Island’s APCD and developed an algorithm to identify individuals prescribed TDF/FTC for PrEP. We compared APCD PrEP data to electronic medical record (EMR) data at the largest dedicated PrEP program in the state, and to other comprehensive pharmaceutical claims data (AIDSVu.org). We calculated the PrEP-to-Need ratio (PnR) based on annual HIV incidence, and used multivariable logistic regression to predict ZIP code-level PrEP use, and specialty of prescribing provider (primary care vs. infectious disease).ResultsThe Rhode Island APCD included insurance claims for 917,633 individuals (87% of the Rhode Island population). PrEP use increased substantially in Rhode Island over the 5-year period, from 13 to 331 prescriptions between 2012 and 2017, with 546 total users during this time period. Users were predominantly male (89%) and privately insured (69.1%), and concentrated in Providence County (71.5%). The PnR ratio increased from 0.2 to 4.0 from 2012–2017. Compared with AIDSVu and EMR Data, the APCD underestimated the number of PrEP users in Rhode Island, but improved over time in documenting users. Infectious diseases specialists had 8.4 times the odds (95% CI: 5.4 to 12.9) of being a PrEP prescriber compared with primary care providers. A total of 2.6% of infectious disease specialists were PrEP prescribers compared with 0.33% of PCPs. The proportion of Black or Hispanic individuals in a ZIP-code was not a significant predictor of PrEP use.ConclusionAPCDs offer an innovative approach to evaluate statewide PrEP implementation comprehensively. Engaging PCPs in PrEP implementation is critical to improve overall uptake among populations most at-risk. Disclosures All authors: No reported disclosures.