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 体验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，决策辅助工具 提高了患者对决策的认识，减少了决策冲突， 改善了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患者-提供商决策辅助，以帮助提供商更好地 在实践中理解并有效实施HIV PEP，帮助患者更好地了解 他们在提供艾滋病毒PEP作为选项时所做的决定，以便他们可以更成功地1) 做出决定，以及2)当他们决定启动HIV时，完成整个28天的调解过程 佩普。 建议的患者-提供者决策援助利用一个已知的临床机会来吸引符合以下条件的患者 在开始HIV PEP时有血清转换的风险。通过创建互联网交付的多媒体工具：1) 从讨论过程中消除提供者对什么是艾滋病毒风险的偏见；2)减缓 信息共享和决策的过程，并以简短、可重复的方式呈现信息 模块；以及3)为患者提供了反思已显示出的关键优先事项的机会 影响决策和遵守(例如，社会支持/污名、艾滋病毒风险认知、成本/可获得性、侧面 效果)在做出决定之前，我们预计患者会有较少的决策冲突，感觉更多 对自己的决定充满信心，对于启动HIV PEP的患者来说，能够更好地完成全部28项- 日间养生法。 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-提供者决策辅助开发和后续测试。设计公正的原则(例如，采用 共同设计方法，制定具体的问责机制，以边缘化群体的需求为中心 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，以及未来疗效试验研究的计划细节。

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.