Development of a patient-provider decision aid for HIV post-exposure prophylaxis

项目总结 虽然仍然存在许多关于艾滋病毒PEP可预防传播的具体比率的问题，但与 艾滋病毒血清转换和风险测量的现实世界挑战，我们确实知道：1)在 经历过一次已知的暴露，艾滋病毒PEP是有效的，如果及时启动可能会节省成本 和完全完成；2)已经提供、接受甚至完成HIV PEP的患者继续 报告关于其使用的混乱和不准确的信息；以及3)在许多情况下，决策辅助 证明提高了患者报告的决策知识，减少了决策冲突， 并改善患者与提供者之间的沟通。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决策辅助，以帮助提供商更好地了解和 在实践中有效地实施HIV PEP，并帮助患者更好地理解他们的决定 当提供HIV PEP作为选项以便他们可以更成功地1)做出决定时， 以及2)当他们决定开始HIV PEP时，完成整个28天的药物疗程。 建议的决策辅助工具利用一个已知的临床机会来吸引有风险的患者 HIV-PEP启动中的血清转换。通过创建互联网交付的多媒体工具：1)删除 提供商在讨论过程中对什么是艾滋病毒风险存在偏见；2)减缓了 信息共享和决策，并以简短、可重复的片段呈现信息；以及3) 让患者有机会反思已被证明影响决策的关键方面 制定和遵守(例如，社会支持/污名、艾滋病毒风险认知、成本/获得机会、副作用) 做出我们预期的决定，患者的决策冲突会更少，对自己的 对于启动HIV PEP的患者，能够更好地完成整个方案。 最后，该提案包括通过社区咨询委员会建立关系，以支持以下所有步骤 决策辅助开发和后续测试。设计公正原则(例如采用联合设计 方法，制定具体的问责机制，以边缘化用户的需求为中心)将是 用于与这组患者和医疗保健提供者合作，设计干预的特定方面 内容，并对未来疗效试验研究的细节进行规划。

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 people 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 been demonstrated to improve patient reported knowledge regarding decision making, decrease decisional conflict, and improve patient-provider communication. Given these gaps, the long-term goal of this work is to develop, refine, and validate a technology-delivered 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 medication when they decide to initiate HIV PEP. The proposed 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 pieces; and 3) incorporates an opportunity for patients to reflect on key aspects 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 regimen. Lastly, the proposal includes relationship building via a community advisory board to support all steps of 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 specific aspects of intervention content, and plan details of the future efficacy testing study.