A Multilevel, Multiphase Optimization Strategy for PrEP: Patients and Providers in Primary Care

PrEP 的多层次、多阶段优化策略：初级保健中的患者和提供者

基本信息

批准号：
10818740
负责人：
Elizabeth Lockhart
金额：
$ 79.66万
依托单位：
HENRY FORD HEALTH + MICHIGAN STATE UNIVERSITY HEALTH SCIENCES
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-09-22 至 2028-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10818740
关键词：
AIDS prevention Address Affect Age Awareness Black Populations Black race Clinic Computer Simulation Consolidated Framework for Implementation Research Continuing Education County Critical Care Disparity Effectiveness Effectiveness of Interventions Electronic Health Record Eligibility Determination Epidemic Equity Family Practice Feedback Focus Groups Gender HIV HIV Seronegativity HIV risk Health Health system Healthcare Systems Human immunodeficiency virus test Individual Inequity Injections Internal Medicine Intervention Interview Knowledge Latino Population Lead Maintenance Mediating Mediator Medical Methods Michigan Modification Online Systems Participant Patient Care Patients Persons Population Primary Care Provider Race Randomized Research Rights Risk Risk Assessment Sampling Sex Behavior Sex Orientation Sexual Health Structure System Testing Training United States Work care providers disparity reduction effectiveness testing evidence base experience experimental study innovation insight intervention effect meetings men who have sex with men multiphase optimization strategy novel patient-clinician communication pill post implementation pre-exposure prophylaxis primary care patient primary care provider primary care setting primary outcome provider intervention secondary outcome sex uptake

项目摘要

What we know: There are 1.2 million people in the US who meet the indications for PrEP; yet, disparities exist in uptake. For example, only 9% of Black and 16% of Latino individuals, compared to 65% of White individuals, have been prescribed PrEP. At Henry Ford Health (HFH) system, only 10% of eligible patients have been prescribed PrEP. Primary care is an ideal setting for PrEP to be offered as an HIV prevention method since providers see large numbers of patients who are HIV negative, with some who are at increased risk for HIV, and the primary care setting is often the point of entry to the healthcare system. The multiphase optimization strategy (MOST) framework is a novel, innovative way to identify an efficient intervention. What we will do: In this optimization trial, we will test the effectiveness of intervention components, alone and in combination, on new PrEP prescriptions in primary care at HFH. First, we will generate feedback on context-specific (system and individual level) factors for intervention component delivery via focus groups with providers (n=15) and patients eligible for PrEP (n=30). Then, we will test the four intervention components in an optimization trial, with 16 conditions being implemented at 32 clinics. Finally, we will generate feedback on the factors that affected implementation via semi-structured interviews with providers (n=30) and patients (n=30). Participants will be primary care providers (PCPs) and patients eligible for PrEP in Henry Ford Health System. Clinics will be randomized (yes/no) to receive any combination of provider and patient intervention components. Provider intervention components include computer-based simulation training and/or best practice alerts delivered via the electronic health record (EHR). Patient intervention components include HIV risk assessment and/or PrEP informational video – both delivered via the EHR. Primary outcome is the rate of new PrEP prescriptions at the clinic level. Secondary outcomes will include PrEP maintenance, number of HIV tests ordered by a PCP, and number of PCPs trained. Sub analyses will test which factors moderate (e.g., patient sex, race, age, gender, sexual orientation) or mediate (e.g., perceived HIV risk, provider and patient PrEP knowledge) PrEP uptake, focusing on priority populations and disparities in rates of PrEP prescription. Implications: 1) Understanding which intervention components lead to increased PrEP prescriptions will represent an important advance in HIV prevention efforts. 2) Optimizing a multi-level intervention for providers and patients to increase PrEP prescriptions would lead to a new, efficient, evidence-based option. 3) Determining what factors are related to PrEP uptake will help reduce disparities in PrEP initiation among those most in need. 4) Understanding the context specific factors related to intervention component implementation will help identify best methods for replication/adaptation in other healthcare systems. In sum, our team brings a novel, innovative approach, robust interdisciplinary experience, strong preliminary work in HIV, PrEP, MOST, and primary care, and scientific rigor to make a significant impact on the field.

我们所知道的：在美国有120万人满足准备迹象；然而，存在差异在吸收中。例如，只有9％的黑人和16％的拉丁裔个体，而白人中有65％已开处方准备。在亨利·福特（Henry Ford）健康（HFH）系统中，只有10％的合格患者是规定准备。初级保健是预防艾滋病毒预防方法的理想场所，因为提供者看到大量艾滋病毒阴性患者，其中一些患者患艾滋病毒的风险增加，初级保健环境通常是进入医疗保健系统的点。多相优化策略（大多数）框架是一种新颖，创新的方法来确定有效的干预措施。我们将要做什么：在在这项优化试验中，我们将单独和联合使用干预组件的有效性 HFH初级保健的新准备处方。首先，我们将对特定于上下文的反馈（系统和个人级别）通过焦点组与提供者（n = 15）和有资格获得PREP的患者（n = 30）。然后，我们将在优化试验中测试四个干预组件，在32个诊所实施了16个条件。最后，我们将对这些因素产生反馈通过对提供者（n = 30）和患者（n = 30）的半结构化访谈（n = 30）来影响实施。参与者将是初级保健提供者（PCP）和有资格在亨利·福特卫生系统中获得PREP的患者。诊所会随机（是/否）接收提供者和患者干预组件的组合。提供者干预组件包括基于计算机的仿真培训和/或通过电子健康记录（EHR）。患者干预组件包括艾滋病毒风险评估和/或PREP 信息视频 - 均通过EHR提供。主要结果是在诊所水平。次要结果将包括准备维护，PCP订购的HIV测试数量以及训练有素的PCP数量。子分析将测试哪些因素中等（例如，患者性别，种族，年龄，性别，性取向）或中介（例如，感知的艾滋病毒风险，提供者和患者准备知识）的准备摄取，专注于优先人群和准备处方率的差异。含义：1）理解哪些干预措施导致准备处方的增加将代表重要的进步艾滋病毒预防工作。 2）优化多层干预措施，以供提供者和患者增加PREP 处方将导致一种新的，高效的循证选择。 3）确定哪些因素与准备吸收将有助于减少最有需要的人的准备启动的分布。 4）理解与干预组件实施相关的上下文特定因素将有助于确定最佳方法其他医疗保健系统中的复制/适应。总而言之，我们的团队带来了一种新颖，创新的方法，强大的跨学科经验，在艾滋病毒，预科，大多数和初级保健方面的强大初步工作以及对该领域产生重大影响的科学严谨性。