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.

项目摘要尽管关于艾滋病毒PEP的特定利率仍然存在许多问题，可预防与现实世界的艾滋病毒血清转化和衡量风险的挑战，我们确实知道：1）体验已知的曝光HIV PEP是有效的，如果及时发起的，则可以节省成本并完全完成； 2）被提供，接受甚至完成的艾滋病毒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，决策辅助工具有证明患者对决策，决策冲突减少的知识得到了提高，并且改善了患者支持者的沟通。鉴于这些差距，这项工作的长期目标是发展，精炼并验证技术提供的患者提供者的决策援助，以帮助提供者更好理解并有效地实施HIV PEP，并帮助患者更好地了解他们在提供HIV PEP作为一种选择时做出的决定，以便他们可以更成功地做出决定1）做出决定，以及2）完成整个28天的调解课程，他们决定发起艾滋病毒 pep。拟议的患者支持者决策援助利用了已知的临床机会来吸引患者在艾滋病毒PEP启动时有血清转化的风险。通过创建一个互联网传递的多媒体工具：1）消除了有关哪些资格从讨论过程中成为艾滋病毒风险的偏见； 2）减慢信息共享和决策过程的过程中，并在简短可重复的情况下介绍信息模块； 3）为患者提供了一个机会，可以反思已显示的关键优先级影响决策和依从性（例如社会支持/污名，艾滋病毒风险感知，成本/访问，方面效果）在做出决定之前，我们预计患者的决策冲突将减少，感觉更多对他们的决定充满信心，以及对于发起艾滋病毒PEP的患者，可以更完成整个28- 一日疗程。最后，该提案包括通过社区咨询委员会建立关系，以支持患者支持者的决策援助开发和随后的测试。设计正义原则（例如共同设计方法，开发特定的责任机制，以边缘化的需求为中心用户）将用于与这组患者和医疗保健提供者合作，以设计干预内容以及计划未来功效测试研究的细节。