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

项目摘要 虽然关于艾滋病毒PEP可预防传播的具体比率仍有许多问题， 艾滋病毒血清转换和衡量风险的真实的世界挑战，我们确实知道：1）在那些 经历已知的暴露，艾滋病毒PEP是有效的，如果及时启动，可能会节省成本 2）已经提供，接受，甚至完成艾滋病毒PEP的患者继续 报告关于其使用的混乱和不准确的信息; 3）在许多情况下， 经证实可改善患者报告的决策知识，减少决策冲突， 改善医患沟通。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，以帮助提供者更好地理解和 在实践中有效地实施艾滋病毒PEP，并帮助患者更好地了解他们的决定， 当提供艾滋病毒PEP作为一种选择，使他们可以更成功地1）作出决定， 以及2）当他们决定开始HIV PEP时，完成整个28天的药物治疗过程。 所提出的决策辅助利用已知的临床机会来吸引有风险的患者， 启动HIV PEP时的血清转化。通过创建一个互联网提供的多媒体工具，1）删除 提供者在讨论过程中对什么是艾滋病毒风险存在偏见; 2）减缓了 信息共享和决策制定，并以简短、可重复的片段呈现信息;以及3） 为患者提供了一个反思已被证明会影响决策的关键方面的机会 制定和坚持（例如社会支持/耻辱，艾滋病毒风险认知，成本/获取，副作用） 在做出决定时，我们预期患者会有更少的决策冲突，对自己的选择更有信心， 决定，并为病人谁开始艾滋病毒PEP，更能够完成整个方案。 最后，该提案包括通过社区咨询委员会建立关系，以支持 决策辅助开发和后续测试。设计公正原则（例如采用共同设计 方法，制定具体的问责机制，以边缘化用户的需求为中心）， 与这组患者和卫生保健提供者合作，设计具体的干预措施 内容，并计划未来疗效测试研究的细节。

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 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.