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

• 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
• 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

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：美国有120万人符合PrEP的适应症;然而，存在差异 in uptake摄取.例如，只有9%的黑人和16%的拉丁美洲人，而白色人的比例为65%， 在亨利福特健康（HFH）系统，只有10%的合格患者被处方了PrEP。 初级保健是PrEP作为艾滋病毒预防方法提供的理想环境，因为 提供者看到大量艾滋病毒阴性的患者，其中一些人感染艾滋病毒的风险增加， 而初级保健机构往往是进入保健系统的入口。多相优化 社会变革管理战略（MOST）框架是确定有效干预措施的一种新颖、创新的方式。我们将做什么：在 在这项优化试验中，我们将测试干预成分单独和组合的有效性， HFH初级保健中的新PrEP处方。首先，我们将生成关于特定于上下文的反馈（系统 和个人水平）因素，通过与提供者的焦点小组提供干预成分（n=15）， 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组件， 32个诊所实施了16项条件。最后，我们将生成有关以下因素的反馈： 通过与提供者（n=30）和患者（n=30）的半结构化访谈影响实施。参与者 将是初级保健提供者（PCP）和有资格在亨利福特卫生系统接受PrEP的患者。诊所将 随机（是/否）接受提供者和患者干预组件的任何组合。提供商 干预部分包括基于计算机的模拟培训和/或最佳实践警报， 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-两者都通过EHR提供。主要结果是新的PrEP处方率， 临床水平。次要结果将包括PrEP维持，PCP订购的HIV检测次数，以及 受训的警察局长人数。子分析将测试哪些因素是温和的（例如，患者性别、种族、年龄、性别， 性取向）或介导（例如，感知的HIV风险，提供者和患者PrEP知识）PrEP摄取， 重点关注优先人群和PrEP处方率的差异。含义：1）理解 哪些干预成分导致增加PrEP处方将代表一个重要的进步， 艾滋病毒预防工作。2)优化提供者和患者的多层次干预，以增加PrEP 处方将导致一个新的，有效的，以证据为基础的选择。3)确定哪些因素与 PrEP吸收将有助于减少最需要的人在PrEP启动方面的差异。4)了解 与干预组成部分的实施有关的特定背景因素将有助于确定最佳方法， 在其他医疗保健系统中进行复制/调整。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和初级保健方面开展了大量的前期工作， 科学的严谨性对该领域产生了重大影响。