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.

我们所知道的是：美国有 120 万人符合 PrEP 的适应症，但存在差异；例如，只有 9% 的黑人和 16% 的拉丁裔人士接受这一比例，而白人的比例为 65%。在 Henry Ford Health (HFH) 系统中，只有 10% 的符合条件的患者接受了 PrEP。初级保健是提供 PrEP 作为 HIV 预防方法的理想场所。提供者看到大量艾滋病毒呈阴性的患者，其中一些患者感染艾滋病毒的风险较高，初级保健机构通常是医疗保健系统的入口点。战略（MOST）框架是一种新颖的、创新的方式来确定有效的干预措施：在这个优化试验中，我们将测试单独和组合干预措施的有效性 HFH 初级保健中的新 PrEP 处方首先，我们将针对特定情况（系统）生成反馈。和个人水平）通过焦点小组与提供者进行干预成分交付的因素（n = 15）和符合 PrEP 条件的患者 (n=30) 然后，我们将在优化试验中测试四个干预措施， 32 家诊所实施了 16 项条件，最后，我们将针对影响因素进行反馈。通过对提供者 (n=30) 和患者 (n=30) 参与者进行半结构化访谈来影响实施。将是初级保健提供者 (PCP)，并且有资格在 Henry Ford Health 诊所接受 PrEP 的患者将是。被随机化（是/否）以接受提供者和患者干预成分的任意组合。干预部分包括基于计算机的模拟培训和/或通过以下方式提供的最佳实践警报电子健康记录 (EHR) 患者干预部分包括 HIV 风险评估和/或 PrEP。信息视频 – 均通过 EHR 提供主要结果是新 PrEP 处方的比率。次要结果将包括 PrEP 维持、PCP 要求的 HIV 检测次数以及接受培训的 PCP 数量。子分析将测试哪些因素具有影响力（例如患者性别、种族、年龄、性别、性取向）或调节（例如感知的 HIV 风险、提供者和患者的 PrEP 知识）PrEP 的吸收，启示：1）理解哪些干预措施会导致 PrEP 处方增加，这将代表着一项重要进展 2) 优化服务提供者和患者的多层次干预措施以增加 PrEP。处方将带来新的、有效的、基于证据的选择 3) 确定与哪些因素相关。 PrEP 的采用将有助于减少最需要的人群在 PrEP 启动方面的差异 4) 了解情况。与干预措施实施相关的具体背景因素将有助于确定最佳方法总之，我们的团队带来了一种新颖的创新方法，丰富的跨学科经验，在艾滋病毒、PrEP、MOST 和初级保健方面强有力的前期工作，以及科学强度对该领域产生重大影响。