Acceptability of a patient-centered decision aid to inform HIV prevention choices and uptake among at-risk male couples

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1 SUMMARY / ABSTRACT 2 3 Gay, bisexual, and other men who have sex with men (MSM) continue to be the group most heavily impacted 4 by HIV in the United States, despite stability or decline in infections among other groups. Up to two-thirds of 5 MSM acquire HIV from their main partner (i.e., male couples). Given the multitude of available HIV prevention 6 options, HIV-negative and HIV-discordant male couples may experience anxiety and decisional conflict in 7 determining which HIV prevention methods to use in their relationship. Moreover, uptake of different evidence- 8 based preventive strategies (e.g., PrEP, nPEP, couples- and individual-level HIV/STI testing) remains subpar 9 in these two groups of male couples, which inhibits the overarching goal to reduce HIV and STI incidence. 10 Patient-centered decision aids (PtDAs) have been shown to reduce decisional conflict and increase uptake of 11 preventative behaviors; however, there are no existing couples-based HIV prevention PtDAs to assist male 12 couples in choosing and then using their selected strategy(ies). The overarching goal of this two-year, mixed 13 method project is to develop and examine the acceptability of a tailored, web-based, patient-centered decision 14 aid (PtDA) to encourage a convenience sample of at-risk HIV-negative and HIV-discordant male couples in 15 new relationships to develop a prevention plan, and order and use their selected prevention strategies based 16 on their plan. Method: All project activities will be web-based. First, semi-structured, individual qualitative 17 interviews will be conducted with both partners of 30 male couples (n=60 men), who are in new relationships, 18 to examine perceived barriers and facilitators of partners’ decision-making processes to use prevention 19 strategies in their relationship (Aim 1). Findings from Aim 1 will be combined and applied to the proposed 20 outline, design, and experience of the PtDA with the web development company, consultant, and community 21 advisory board (CAB). The CAB and investigative team will then test the prototype and alpha version of the 22 PtDA before beginning Aim 2 with the beta version of it. With the use of a different convenience sample of 30 23 eligible male couples in new relationships (Aim 2), the acceptability of the PtDA will be assessed to (1) create a 24 prevention plan that meets their needs, and (2) order and (3) use/intend to use their selected HIV preventive 25 strategy(ies) in the near future. Acceptability of the PtDA’s (4) content, (5) exercises, (6) menu-order system, 26 and (7) aesthetic appeal will also be examined. Semi-structured, individual interviews will be conducted 1 27 month after being given access to use the PtDA to examine primary acceptability outcomes 1-3, and 28 secondary outcomes 4-7. The sample – for both aims – will be stratified (e.g., race/ethnicity, couples’ HIV- 29 status). Significance: If acceptability of the HIV prevention PtDA is high and shows initial promise to improve 30 uptake and use of evidence-based strategies, our findings will support follow-up with a R01 application to test 31 the intervention efficacy in a fully powered randomized controlled trial with a larger diverse sample of at-risk 32 HIV-negative and HIV-discordant male couples in new relationships.