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：
10548466
负责人：
Jocelyn Christine Anderson
金额：
$ 25.33万
依托单位：
PENNSYLVANIA STATE UNIVERSITY, THE
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 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10548466
关键词：
Accountability Acquired Immunodeficiency Syndrome Acute Adherence Administrator Adopted Age Anti-Retroviral Agents Area Caring Centers for Disease Control and Prevention (U.S.)Clinical Communication Communities Complex Conflict (Psychology)Confusion Cost Savings Data Decision Aid Decision Making Development District of Columbia Effectiveness Emotional Epidemic Exposure to Feedback Financial Hardship Forensic Medicine Future Goals HIV HIV Seropositivity HIV risk Health Personnel Health behavior Hour Individual International Internet Intervention Justice Knowledge Measures Mediation Medical Methods Multimedia Nurses Output Patient Care Patients Pattern Perception Personal Satisfaction Persons Pharmaceutical Preparations Prevention Guidelines Privacy Process Prophylactic treatment Provider Race Recommendation Regimen Relationship-Building Reporting Risk Science Social support Source Standardization Surveys Technology Testing Time Translating Unsafe Sex Variant Work World Health Organization acceptability and feasibility base care outcomes case-by-case basis clinical decision-making clinical practice cognitive interview cost cost effective cost estimate design digital efficacy testing evidence base experience follow-up high risk improved intravenous drug use life time cost marginalized population patient population patient-clinician communication perpetrators pill prevent programs prototype provider behavior response risk perception risk sharing seroconversion sexual assault shared decision making 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 individuals 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 demonstrated improved patient knowledge regarding decision making, decreased decisional conflict, and improved patient-provider communication. Given these gaps, the long-term goal of this work is to develop, refine, and validate a technology-delivered patient-provider 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 mediation when they decide to initiate HIV PEP. The proposed patient-provider 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 modules; and 3) incorporates an opportunity for patients to reflect on key priorities 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 28- day regimen. Lastly, the proposal includes relationship building via a community advisory board to support all steps of the patient-provider 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 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：经历已知的暴露 HIV PEP 如果及时启动，是有效的，并且可能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，决策辅助工具具有表现出患者对决策的了解有所提高，减少了决策冲突，并且改善患者与提供者的沟通。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患者-提供者决策援助，以帮助提供者更好地了解并在实践中有效实施 HIV PEP，并帮助患者更好地了解他们在获得 HIV PEP 作为一种选择时做出的决定，以便他们能够更成功 1) 做出决定，并且 2) 当他们决定启动 HIV 时，完成整个 28 天的调解过程政治人物。拟议的患者提供者决策辅助利用已知的临床机会来吸引有以下情况的患者：在开始 HIV PEP 时面临血清转化的风险。通过创建一个互联网交付的多媒体工具：1) 从讨论过程中消除提供者对艾滋病毒风险的偏见； 2）减慢信息共享和决策的过程被简化并以简短、可重复的方式呈现信息模块； 3) 为患者提供了反思关键优先事项的机会，这些优先事项已被证明可以影响决策和遵守（例如社会支持/耻辱、艾滋病毒风险认知、成本/获取、侧面效果）在做出决定之前，我们预计患者的决策冲突会减少，感觉会更加强烈对自己的决定充满信心，并且对于开始 HIV PEP 的患者来说，更有能力完成整个 28- 日间养生法。最后，该提案包括通过社区咨询委员会建立关系，以支持该项目的所有步骤。患者-提供者决策辅助开发和后续测试。设计正义的原则（例如采用共同设计方法，制定具体的问责机制，以边缘化群体的需求为中心用户）将用于与这组患者和医疗保健提供者合作，设计以下方面：干预内容，以及未来功效测试研究的计划细节。