Development of a patient-provider decision aid for HIV post-exposure prophylaxis

开发艾滋病毒暴露后预防的患者-提供者决策辅助工具

基本信息

批准号：
10836150
负责人：
Jocelyn Christine Anderson
金额：
$ 24.87万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-07-01 至 2025-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10836150
关键词：
Accountability Acquired Immunodeficiency Syndrome Acute Adherence Adopted Age Anti-Retroviral Agents Area Caring Centers for Disease Control and Prevention (U.S.)Clinical Communities Complex Conflict (Psychology)Confusion Cost Savings Data Decision Aid Decision Making Development District of Columbia Education Effectiveness Emotional Epidemic Equity Exposure to Feedback Financial Hardship Forensic Medicine Future Goals HIV HIV Seropositivity HIV risk Health Personnel Health behavior Hour Inequity International Internet Intervention Justice Knowledge Measures Medical Methods Multimedia Nurses Outcome Output Patient Care Patients Pattern Perception Personal Satisfaction Persons Pharmaceutical Preparations Populations at Risk Prevention Guidelines Privacy Process Prophylactic treatment Provider Qualifying Race Recommendation Regimen Relationship-Building Reporting Risk Science Social support Source Standardization Surveys Technology Testing Translating Unsafe Sex Variant Viral Work World Health Organization acceptability and feasibility case-by-case basis clinical practice cognitive interview cost cost effectiveness cost estimate design digital efficacy testing evidence base experience follow-up high risk improved intravenous drug use life time cost marginalization marginalized population patient engagement patient-clinician communication perpetrators pill prevent programs prototype provider behavior provider communication response risk perception risk sharing seroconversion sexual assault side effect social stigma theories therapy development tool transmission process

项目摘要

PROJECT SUMMARY While many questions remain regarding specific rates for HIV PEP preventable transmissions related to the real world challenges of HIV seroconversion and measuring risk, we do know that: 1) among people who experience a known exposure, HIV PEP is effective and potentially cost saving if initiated in a timely manner and completed fully; 2) patients who have been offered, accepted, and even completed HIV PEP continue to report confusion and inaccurate information regarding its use; and 3) in many contexts decision aids have been demonstrated to improve patient reported knowledge regarding decision making, decrease decisional conflict, and improve patient-provider communication. Given these gaps, the long-term goal of this work is to develop, refine, and validate a technology-delivered decision aid to assist providers in better understanding and effectively implementing HIV PEP in practice, and assist patients to better understand the decision they are making when provided with HIV PEP as an option so that they may more successfully 1) make the decision, and 2) complete the entire 28-day course of medication when they decide to initiate HIV PEP. The proposed decision aid leverages a known clinical opportunity to engage patients who are at risk for seroconversion in initiation of HIV PEP. By creating an internet-delivered multimedia tool that: 1) removes provider biases regarding what qualifies as an HIV risk from the discussion process; 2) slows the process of information sharing and decision making down and presents information in short, repeatable pieces; and 3) incorporates an opportunity for patients to reflect on key aspects that have been shown to impact decision making and adherence (e.g. social support/stigma, HIV risk perception, cost/access, side effects) prior to making the decision we anticipate that patients will have less decisional conflict, feel more confident about their decision, and for patients who initiate HIV PEP, be more able to complete the entire regimen. Lastly, the proposal includes relationship building via a community advisory board to support all steps of decision aid development and subsequent testing. Principles of design justice (e.g. adopting co-design methods, developing specific mechanisms for accountability, centering the needs of marginalized users) will be used to partner with this group of patient and health care providers to design specific aspects of intervention content, and plan details of the future efficacy testing study.

项目概要尽管与艾滋病毒 PEP 可预防传播的具体比率有关，但仍存在许多问题。面对艾滋病毒血清转化和测量风险的现实世界挑战，我们确实知道：1) 在以下人群中：经历已知暴露后，HIV PEP 是有效的，如果及时启动，可能会节省成本并完全完成； 2) 已提供、接受甚至完成 HIV PEP 的患者继续报告有关其使用的混乱和不准确的信息； 3) 在许多情况下，决策辅助工具已被证明可以提高患者报告的有关决策的知识，减少决策冲突，并改善医患沟通。鉴于这些差距，这项工作的长期目标是开发、完善和验证技术提供的决策辅助，以帮助提供商更好地理解和在实践中有效实施 HIV PEP，并帮助患者更好地理解他们的决定当提供 HIV PEP 作为一种选择时，他们可以更成功地做出决定 1) 做出决定， 2) 当他们决定开始 HIV PEP 时，完成整个 28 天的药物治疗过程。拟议的决策援助利用已知的临床机会来吸引有风险的患者 HIV PEP 启动时的血清转化。通过创建一个互联网交付的多媒体工具，该工具：1）删除提供者对讨论过程中的 HIV 风险存在偏见； 2）减慢进程信息共享和决策制定并以简短、可重复的形式呈现信息；和 3) 为患者提供了反思已被证明影响决策的关键方面的机会之前的制定和遵守（例如社会支持/耻辱、艾滋病毒风险认知、成本/获取、副作用）我们预计患者在做出决定时会有更少的决策冲突，对自己的决定更有信心决定，并且对于开始 HIV PEP 的患者来说，更有能力完成整个治疗方案。最后，该提案包括通过社区咨询委员会建立关系，以支持所有步骤决策辅助开发和后续测试。设计公正的原则（例如采用协同设计方法、制定具体的问责机制、以边缘化用户的需求为中心）用于与这组患者和医疗保健提供者合作设计干预的具体方面未来功效测试研究的内容和计划细节。