Adaptation of a PrEP Shared-Decision Making Tool for Family Planning Clinics

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PROJECT SUMMARY/ABSTRACT Cisgender women account for ~20% of new HIV infections in the US, and are systematically under-accessed for HIV prevention. The intersection of patient-side barriers (lack of patient knowledge, perceived risk, and medical mistrust), and provider-side barriers (lack of knowledge, discomfort with prevention counseling, and bias) impacts uptake of novel HIV prevention methods, such as available and forthcoming methods of pre-ex- posure prophylaxis (PrEP) for HIV (oral, injectable, etc.). To address these barriers, the trainee (Ms. Anderson) will adapt a family planning (FP) shared decision-making (SDM) tool for use in HIV prevention counseling. SDM involves introducing choice, describing options, and exploring patient preferences to aid in health care decisions, while empowering women, decreasing provider bias, increasing satisfaction with care, and increas- ing adherence to care regimens. The adapted tool will be tested for acceptability/feasibility with providers and clients at Title X federally-funded FP clinics, a high-reach setting for women at risk for HIV from heterosexual contact. Guided by the ADAPT-ITT framework for adaptation, the specific aims are to (1) assess the utility of SDM practices for HIV prevention and barriers/facilitators to implementation, through (a) focus groups with Title X providers in Metro Atlanta (K=4, N=32) and (b) theater testing interviews with racially/ethnically diverse cis- gender adult Title X clients (N=40); (2) adapt the evidence-based World Health Organization (WHO) Decision- Making Tool for FP Clients and Providers for HIV prevention; and, (3) conduct mixed-method acceptability/fea- sibility testing of the adapted SDM tool with Title X providers (N=40) and clients (N=40). This study will result in an acceptable and feasible HIV prevention SDM tool for use with cisgender women attending FP clinics, to be further tested and disseminated to promote HIV prevention among women, advancing efforts to end the HIV epidemic. Additionally, this work will support the training of Ms. Anderson, who is committed to becoming a high caliber, NIH-funded researcher in HIV prevention and treatment, and improvement of care interactions. Ms. Anderson’s 3-year training plan includes: (1) formally developing methodological skills in implementation science and human-centered design, (2) advancing understanding of the context of clinical HIV prevention, including biomedical prevention and clinical interactions, and (3) developing skills in the areas of measurement and evaluation of interventions and interventional pathways. The team of mentors, Drs. Sales (Primary Spon- sor), Sheth (Co-Sponsor), and Kottke (Expert Advisor), will provide oversight, guidance, and mentorship to Ms. Anderson during the course of her training, in the topic areas of implementation science, HIV prevention, clini- cal interactions, and intervention evaluation. Ms. Anderson will leverage resources at Emory University, includ- ing the Network for Evaluation and Implementation Sciences, the Network for Evaluation and Implementation Science, the Women and Children’s Center, and the Prevention Research Center. The candidate, mentorship team, and the environment are extremely well situated to achieve the proposed research and training aims.