Informing and promoting Shared decision making for HIV Prevention and Alcohol Reduction: Engaging Diverse Veterans to Refine and Pilot a Decision Aid (SHARE Study)

为预防艾滋病毒和减少饮酒提供信息并促进共同决策：让不同的退伍军人参与完善和试点决策援助（SHARE 研究）

• 批准号: 10540922
• 负责人: E. Jennifer Edelman
• 金额: $ 24.4万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10540922
• 关键词: AIDS prevention; Address; Adult; Alcohol consumption; Alcohols; Algorithms; Attention; Behavior; Caring; Communities; Consolidated Framework for Implementation Research; Continuity of Patient Care; Data; Decision Aid; Decision Making; Discover, Design, Build, and Test Framework; Electronic Health Record; Epidemic; Evidence based intervention; Fostering; Foundations; Gender; Gender Identity; Geographic Locations; HIV; Health; Health Disparities Research; Hearing; Incidence; Individual; Intervention; Interview; Knowledge; Medicine; Methodology; Methods; National Institute on Alcohol Abuse and Alcoholism; Natural Language Processing; Outpatients; Patients; Pattern; Persons; Pharmaceutical Preparations; Population; Primary Care Physician; Primary Health Care; Process; Provider; Race; Recommendation; Research; Risk Factors; Safe Sex; Sampling; Sex Orientation; Sexual and Gender Minorities; Stigmatization; Structure; Subgroup; Testing; United States; Variant; Veterans; Veterans Health Administration; Viral; Visit; Work; addiction; alcohol abuse therapy; alcohol misuse; cognitive interview; design; disorder prevention; ethnic identity; evidence base; experience; implementation science; improved; individual variation; innovation; marginalized population; modifiable risk; novel; patient oriented; patient subsets; pilot test; pre-exposure prophylaxis; preference; prevent; preventive intervention; primary care setting; racial and ethnic; racial identity; recruit; sexual identity; sexual minority group; shared decision making; targeted treatment; theories; traditional care; transgender; transmission process; treatment as prevention; uptake; usability

ABSTRACT Preventing HIV transmission with enhanced Pre-exposure Prophylaxis (PrEP) access, particularly among marginalized populations with disproportionate HIV incidence (e.g., minoritized racial/ethnic and sexual orientation and gender groups), is a crucial step in ending the HIV epidemic. Though unhealthy alcohol use is a central modifiable risk factor for HIV incidence and over-represented among marginalized populations, few HIV prevention interventions exist that synergistically address both unhealthy alcohol use and PrEP. Research is needed to understand PrEP uptake among individuals with unhealthy alcohol use and to develop scalable patient-centered interventions that synergistically address unhealthy alcohol use and HIV. The Veterans Health administration (VA) is a leader in provision of evidence-based care for unhealthy alcohol use, yet substantial gaps in PrEP implementation for Veterans with unhealthy alcohol use exist—our preliminary research suggests major gaps in PrEP knowledge, use, and reach, and Veterans with unhealthy alcohol use. Evidence-based interventions/treatments are available for unhealthy alcohol use, but alcohol use is historically under targeted in HIV prevention interventions. Our team of interdisciplinary experts in HIV and addiction medicine, the intersection of alcohol use and HIV, implementation science, health disparities research, and community-partnered research will use sequential mixed methods guided by socioecological theory, the Consolidated Framework for Implementation Science, and the Discover/Design/Build/Test (DDBT) process to understand the impact of unhealthy alcohol use on the PrEP care continuum and then refine an existing decision aid to increase PrEP initiation in primary care at the point of alcohol-related care in the VA. Quantitative work will include ~1.9 million individuals, including adequate numbers of minoritized patients (e.g., ~115,000 individuals with minoritized sexual orientation and ~11,000 individuals with minoritized gender identity) and will assess variation in patterns of PrEP initiation and persistence across VA facilities and patient subgroups (Aim 1). Findings will be used to inform purposive sampling for qualitative work to refine (Aim 2) and then pilot test an existing decision aid for developed previously with NIAAA support (Aim 3). Our study is patient-centered and innovative in characterizing PrEP care overall and within diverse subgroups of patients with and without unhealthy alcohol use, leveraging a novel natural language processing (NLP)--driven algorithm for identifying sexual minority groups, and tailoring an existing decision aid to facilitate shared decision-making for co-occurring HIV prevention and alcohol use. Study activities will be conducted with iterative input from a community advisory board. The study is highly responsive to NIAAA priorities and has potential for high impact as it will lay foundation for integrating a patient- centered and multi-targeted novel decision aid for HIV prevention in routine primary care settings that may have potential to increase equity in care.

抽象的 通过加强暴露前预防 (PrEP) 预防艾滋病毒传播，特别是在人群中 艾滋病毒发病率不成比例的边缘化人群（例如少数种族/族裔和性别群体） 尽管不健康的饮酒是结束艾滋病毒流行的关键一步。 艾滋病毒发病率的核心可改变危险因素，在边缘化人群中比例过高，很少有艾滋病毒感染者 现有的预防干预措施可以协同解决不健康的饮酒和 PrEP 研究。 需要了解不健康饮酒人群的 PrEP 吸收情况并开发可扩展的 以患者为中心的干预措施，协同解决不健康的饮酒和艾滋病毒问题。 管理局（VA）在针对不健康饮酒提供循证护理方面处于领先地位，但仍具有实质性 对于不健康饮酒的退伍军人来说，PrEP 实施方面存在差距——我们的初步研究表明 PrEP 知识、使用和覆盖范围以及不健康饮酒的退伍军人方面存在重大差距。 对于不健康的饮酒，可以采取干预措施/治疗，但酒精的使用历来是未针对的目标 我们的艾滋病毒和成瘾医学跨学科专家团队是艾滋病毒预防干预措施的交叉点。 酒精使用和艾滋病毒、实施科学、健康差异研究和社区合作研究 将使用以社会生态学理论（综合框架）为指导的顺序混合方法 实施科学和发现/设计/构建/测试 (DDBT) 流程，以了解影响 PrEP 护理连续体中不健康的饮酒，然后完善现有的决策辅助以增加 PrEP VA 中与酒精相关的护理开始初级护理的数量将包括约 190 万。 个体，包括足够数量的少数群体患者（例如，约 115,000 名少数群体患者） 性取向和约 11,000 名具有少数性别认同的人）并将评估模式的变化 VA 机构和患者亚组中 PrEP 的启动和持续性（目标 1）。 为定性工作进行有目的抽样以进行改进（目标 2），然后对现有的决策辅助进行试点测试 先前在 NIAAA 支持下开发（目标 3）。我们的研究以患者为中心，在表征方面具有创新性。 总体上以及在有或没有不健康饮酒的患者的不同亚组中进行 PrEP 护理，利用 新颖的自然语言处理（NLP）驱动的算法，用于识别性少数群体并进行定制 现有的决策辅助工具，可促进同时发生的艾滋病毒预防和饮酒的共同决策。 研究活动将在社区咨询委员会的反复投入下进行。该研究非常有效。 响应 NIAAA 的优先事项，并具有产生巨大影响的潜力，因为它将为整合患者- 在常规初级保健机构中预防艾滋病毒的以中心和多目标为中心的新型决策援助可能具有 增加护理公平性的潜力。