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

• 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
• 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

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.

项目摘要 虽然关于与艾滋病毒相关的PEP可预防传播的具体比率仍存在许多问题 艾滋病毒血清转换和衡量风险的真实的世界挑战，我们确实知道：1）在那些 如果及时启动，已知暴露HIV的PEP是有效的，并可能节省成本 2）已经提供，接受，甚至完成艾滋病毒PEP的患者继续 报告关于其使用的混乱和不准确的信息; 3）在许多情况下， 证明患者对决策的了解有所改善，决策冲突减少， 改善医患沟通。鉴于这些差距，这项工作的长期目标是发展， 完善和验证技术提供的患者-提供者决策辅助，以帮助提供者更好地 了解和有效地实施艾滋病毒PEP在实践中，并协助病人更好地了解 当提供艾滋病毒PEP作为一种选择时，他们正在做出决定，以便他们可以更成功1） 做出决定，2）当他们决定启动艾滋病毒时，完成整个28天的调解课程 PEP。 拟议的患者-提供者决策辅助工具利用已知的临床机会， 在启动HIV PEP时有血清转化的风险。通过创建一个互联网提供的多媒体工具，1） 从讨论过程中消除了提供者关于什么是艾滋病毒风险的偏见; 2）减缓了 信息共享和决策制定的过程，并以简短、可重复的方式呈现信息 模块;和3）为患者提供了一个反思已被证明 影响决策和坚持（如社会支持/耻辱，艾滋病毒风险认知，成本/获取，边 在做出决定之前，我们预计患者会有更少的决策冲突， 对自己的决定有信心，对于启动艾滋病毒PEP的患者，更能够完成整个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 患者-提供者决策辅助开发和后续测试。设计公正原则（例如： 共同设计方法，制定具体的问责机制， 用户）将用于与这组患者和医疗保健提供者合作， 干预内容，并计划未来疗效测试研究的细节。