Developing a Web-Based Geolocated Directory of HIV Pre-Exposure Prophylaxis-Providing Clinics: The PrEP Locator Protocol and Operating Procedures.
Developing a Web-Based Geolocated Directory of HIV Pre-Exposure Prophylaxis-Providing Clinics: The PrEP Locator Protocol and Operating Procedures.
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DOI：
10.2196/publichealth.7902
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发表时间：
2017-09-06
影响因子：
8.5
通讯作者：
Sullivan PS
中科院分区：
文献类型：
--
作者：
Siegler AJ;Wirtz S;Weber S;Sullivan PS
人类免疫缺陷病毒(HIV)暴露前预防(PrEP)在预防艾滋病毒传播方面非常有效，但有兴趣了解更多PrEP或获得PrEP处方的患者可能无法找到愿意开PrEP处方的当地医疗提供者。我们试图创建一个提供PrEP诊所的国家数据库，允许患者在一个易于访问的数据库中访问统一的、经过审查的PrEP提供者来源。为了制定PrEP定位器的协议和操作程序，我们对组织PrEP或其他HIV服务目录的专家进行了一系列7次关键线人访谈。我们召集了一个外部咨询委员会和一个合作者委员会，以获取专家和基于社区的观点。在2016年9月公开发布时，该数据库包括1,272家提供PrEP的诊所，包括所有50个州和波多黎各的诊所。网络搜索、转诊和联系州卫生部门确定了58个提供PrEP诊所的独特名单，其中33个来自州卫生部门，6个来自政府地方，2个来自专业医疗组织，19个来自非政府组织。在从名单和网络搜索中确定的2420家诊所中，我们删除了798个重复条目，并确定有350个不符合列入名单的条件。最常见的不合格原因是没有适当的医生执照来开PrEP(67/350)或没有根据自我报告开PrEP(192/350)。关键的信息者访谈形成了重要的方案决策，例如将诊所而不是单个临床医生列为主要数据元素，并简化数据收集以促进可扩展性。我们开发了一个Web界面，以提供对数据的公共访问，具有地理位置数据显示、搜索过滤功能、用于新诊所的公共建议的Web表单以及可嵌入网站的公开可用的目录Web工具。在发布后的6个月里，preplocator.org和托管网站收到了35000多个独特的浏览量和300个诊所添加的内容，5个网站开始托管该小工具。许多预防和治疗服务都有名录。随着新的医疗应用的出现，将有相应的需要开发新的服务提供目录。地理位置目录可以帮助患者获得护理，并有可能增加对更新、更有效的医疗干预的需求和获得。服务目录开发的早期选择会产生长期影响，因为一旦开始收集数据，就很难改变方向。PrEP定位器协议可以在未来服务目录的开发中通知早期决策。此外，关于开发PrEP定位器的案例研究表明，在确定可指导目录开发决策的特定服务因素方面，形成性工作的重要性。
Human immunodeficiency virus (HIV) pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV transmission, yet patients interested in learning more about PrEP or in getting a PrEP prescription may not be able to find local medical providers willing to prescribe PrEP. We sought to create a national database of PrEP-providing clinics to allow for patients to have access to a unified, vetted source of PrEP providers in an easily accessible database. To develop the protocol and operating procedures for the PrEP Locator, we conducted a series of 7 key informant interviews with experts who had organized PrEP or other HIV service directories. We convened an external advisory committee and a collaborators board to gain expert and community-situated perspectives. At its public release in September 2016, the database included 1,272 PrEP-providing clinics, including clinics in all 50 states and in Puerto Rico. Web searches, referrals, and outreach to state health departments identified 58 unique lists of PrEP-providing clinics, with 33 from state health departments, 6 from government localities, 2 from professional medical organizations, and 19 from nongovernmental organizations. Out of the 2,420 clinics identified from the lists and Web searches, we removed 798 as duplicate entries, and we determined that 350 were ineligible for listing. The most common reasons for ineligibility were not having the appropriate medical licensure to prescribe PrEP (67/350) or not prescribing PrEP, based on self-report (192/350). Key informant interviews shaped important protocol decisions, such as listing clinics instead of individual clinicians as the primary data element and streamlining data collection to facilitate scalability. We developed a Web interface to provide public access to the data, with geolocated data display, search filter functionality, a webform for public suggestions of new clinics, and a publicly available directory Web tool that can be embedded in websites. In the 6 months following release, preplocator.org and hosting websites had received over 35,000 unique views and 300 clinic additions, and 5 websites had initiated hosting of the widget. Directories exist for many preventive and treatment services. As new medical applications become available, there will be a corresponding need to develop new directories for service provision. Geolocated directories can assist patients in accessing care and have the potential to increase demand for and access to newer, more efficacious medical interventions. Early choices in the development of service directories have long-lasting impact, because once data collection begins, it can be challenging to reverse course. The PrEP Locator protocol may inform early decisions in the development of future service directories. Additionally, the case study on developing the PrEP Locator demonstrates the importance of formative work in identifying service-specific factors that can guide decisions on directory development.