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

1概要/摘要 2 男同性恋、双性恋和其他男男性行为者（MSM）仍然是受影响最严重的群体。 4艾滋病毒在美国，尽管稳定或其他群体之间的感染下降。多达三分之二的 5男男性行为者从其主要伴侣处感染艾滋病毒（即，男性伴侣）。鉴于现有的艾滋病毒预防措施众多， 6个选项，艾滋病毒阴性和艾滋病毒不和谐的男性夫妇可能会经历焦虑和决策冲突， 7确定在他们的关系中使用哪些艾滋病毒预防方法。此外，对不同证据的吸收- 8个预防策略（例如，PrEP、nPEP、夫妇和个人层面的艾滋病毒/性传播感染检测）仍然低于标准 这两组男性夫妇中有9人感染了艾滋病毒，这阻碍了降低艾滋病毒和性传播感染发病率的总体目标。 10以患者为中心的决策辅助工具（PtDA）已被证明可以减少决策冲突并增加对 11种预防行为;但是，目前没有基于夫妇的艾滋病毒预防PtDA来帮助男性 12对夫妇选择，然后使用他们选择的策略。这两年的总体目标，混合 13方法项目是开发和检查一个量身定制的，基于网络的，以病人为中心的决定的可接受性 14援助（PtDA）鼓励对高危艾滋病毒阴性和艾滋病毒不一致的男性夫妇进行方便抽样 15个新的关系，以制定预防计划，并订购和使用其选定的预防战略， 16、你的计划方法：所有项目活动都将以网络为基础。第一，半结构化，个性化 将对30对男性夫妇（n=60名男性）的伴侣进行17次访谈，他们处于新的关系中， 18审查伙伴利用预防的决策过程中的已知障碍和促进因素 19策略在他们的关系（目标1）。目标1的结果将被合并并应用于拟议的 20大纲，设计，和经验的PtDA与网络开发公司，顾问，和社区 21咨询委员会（CAB）。然后，CAB和调查小组将测试 22 PtDA在开始目标2与它的测试版之前。与使用不同的便利样本30 23对新关系中的合格男性夫妇（目标2），将评估PtDA的可接受性，以（1）创建一个 24预防计划，满足他们的需求，（2）订单和（3）使用/打算使用他们选择的艾滋病毒预防 在不久的将来的25个战略。PtDA的可接受性（4）内容，（5）练习，（6）菜单订购系统， 26和（7）审美情趣也将被审查。将进行半结构化的个人面试1 获得使用PtDA检查主要可接受性结局1-3的权限后27个月，以及 28个次要结局4-7。对于这两个目标，样本将被分层（例如，种族/民族，夫妇艾滋病毒- 29状态）。意义：如果艾滋病毒预防的可接受性很高，并显示出改善的初步希望， 30摄取和使用循证策略，我们的研究结果将支持后续的R 01应用程序测试 31在一项具有更大风险的多样化样本的完全把握度随机对照试验中的干预疗效 32对艾滋病毒阴性和艾滋病毒不和谐的男性夫妇在新的关系。

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.