Patient-facing decision support for HIV and sexually transmitted infection prevention in low-income and minority patient populations.

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Project Summary: The overarching goal of this project is to provide Dr. Jackman with a rich training program that adequately prepares him to become an independent investigator focused on the development and implementation of digital healthcare interventions to address health disparities among minoritized populations. The United States has experienced record-breaking highs in sexually transmitted infection (STI) incidence and persistent disparities in STIs and human immunodeficiency virus (HIV) infections and sequelae among adolescent and young adult (AYA), low income, and Black/African-American populations. Serious adverse health consequences are attributable to STIs, including pelvic inflammatory disease, ectopic pregnancy, congenital syphilis, HIV, and infertility in an estimated 20,000 U.S. women annually. Patient centered clinical decision support (PC CDS) are personalized, patient-centric, patient-facing digital healthcare applications used to deliver patient care between health visits. This proposed program will leverage the electronic health record (EHR) patient portal in a novel PC CDS intervention to optimize sexual health decision making, partner communication, and uptake of clinical services among AYA aged 15 to 25 years in Baltimore, MD. Preliminary studies demonstrate the promise of EHR patient portal-based interventions to help youth overcome barriers such as, limited STI/HIV testing and treatment access, the stigma that often leads to non-disclosure, disclosure inaccuracies, and access to high quality and accurate STI/HIV-related information and resources. Recently, language included in the 21st Century Cures Act Final Rule, National HIV/AIDS Strategy, and STI National Strategic Plan bolsters patient portals as a critical tool for improving patient healthcare engagement. However, as reliance on patient portals and telehealth services have increased since the COVID-19 pandemic, so does the risk of perpetuating inequities in healthcare access among socioeconomically underserved youth. Yet, there is a considerable lack of interventions designed using a paradigm that amplifies the unique voices and experiences of minoritized AYA end-users to meet their healthcare engagement needs and preferences for STI/HIV prevention through the patient portal. This mentored research career development award is designed to provide the necessary training to excel in digital healthcare research focused on reducing health disparities and contribute to the public health informatics sciences. Research aims are to: (a) Describe longitudinal patterns and correlates of EHR patient portal use among urban AYA patients in a large academic health system; (b) Use a design thinking process to develop a PC CDS intervention to support the uptake of STI/HIV prevention services and behaviors among urban AYA patients via the EHR patient portal, and (c) Conduct a 3- month pilot study to determine feasibility and acceptability of the intervention. This study will provide crucial preliminary data to inform the design of an R01-funded randomized trial to determine the effectiveness of a novel PC CDS intervention to optimize patient portal engagement and reduce STI/HIV risk among urban AYA.