DYnamic decisioN Support for IntegrAting PrEP in Clinics for Young People in Alabama and Botswana (DYNAMIC PrEP)
This study evaluates strategies to improve access to HIV prevention through the integration of pre-exposure prophylaxis (PrEP) into existing healthcare settings, rather than limiting delivery to specialty clinics. The study addresses barriers to PrEP uptake, including limited awareness, stigma, and restricted access, and recognizes that availability alone may not ensure initiation or sustained use.
The study includes two components. First, a longitudinal cohort of current PrEP users will be followed to assess changes in access, preferences, and PrEP use over time in real-world settings. Second, a dynamic decision-support toolkit will be developed and evaluated to support patients and providers in PrEP-related decision-making. The toolkit will include patient- and provider-facing components to support clinical decision-making, improve risk understanding, and facilitate integration of PrEP into routine healthcare. The toolkit will be refined and beta-tested in selected healthcare facilities in Botswana and Alabama.
調査の概要
詳細な説明
Pre-exposure prophylaxis (PrEP) is an evidence-based and effective approach to HIV prevention, yet it has not reached its full potential due to factors such as limited awareness, constrained service resources, and stigma. Currently, most PrEP prescriptions are issued in specialty care settings, offering limited access. Therefore, achieving global implementation goals will require expanding PrEP delivery within other existing health facilities.
Making PrEP available in existing outpatient or inpatient settings alone does not guarantee its initiation or sustained use, even among individuals at risk for HIV acquisition. Appropriate decision-making regarding PrEP use requires collaboration between patients and providers, supported by an enabling clinic infrastructure. Moreover, the PrEP journey can be dynamic, with more PrEP modalities becoming available in recent years, and choices can change over time, underscoring the need for decision-support toolkits that help patients and providers navigate this evolving decision-making process. A decision support toolkit that has components that are either patient- or provider-facing, or both, could enhance patients' risk perception and increase their knowledge of PrEP, enabling them to make informed decisions about its use, as well as decrease the decision-making burden on the provider side.
As such, the investigators aim to (1) propose an implementation strategy that integrates PrEP into existing health facilities and (2) develop a dynamic choice decision support toolkit that supports PrEP integration into these existing health facilities.
Thus, our specific aims are:
- Aim 1: To conduct a prospective cohort study of existing PrEP users to better understand how their PrEP access and choices change over time in real-world settings.
Aim 2: To conduct formative work to better understand the landscape of focal points of integration of PrEP into existing healthcare facilities (Aim 2a) and develop and beta-test a dynamic PrEP toolkit prototype needed to support this integration (Aim 2b), in parallel in Botswana and Alabama.
- 2a: To better understand the landscape of potential focal points for PrEP integration across various healthcare facility types, with attention to the appropriate population, setting, and facility context, and prioritization of 1-2 of such clinic types for subsequent integration.
- 2b: To develop and refine a dynamic PrEP toolkit prototype with components needed to support PrEP integration. Potential dynamic PrEP toolkit components may include, for instance, a patient-facing and provider-facing clinical decision support tool (e.g., decision-making applications), another tool to enable commodities tracking for clinics, etc.
- 2c: To beta-test the refined dynamic PrEP toolkit prototype in the selected 1-2 facility types.
研究の種類
入学 (推定)
連絡先と場所
研究連絡先
- 名前：Rena Patel, MD, MPH
- 電話番号：+12059348145
- メール：renapatel@uabmc.edu
研究場所
-
-
Gaborone
-
Bontleng、Gaborone、ボツワナ
- Princess Marina Hospital
-
コンタクト：
- Bame Bame
- 電話番号：+267 72727347
- メール：bbame@bhp.org.bw
-
コンタクト：
- Chelsea Morroni, MBChB, DFSRH, DTMH, MPhil, MP
- 電話番号：+267 765 24112
- メール：cmorroni@ed.ac.uk
-
-
参加基準
適格基準
就学可能な年齢
- 大人
- 高齢者
健康ボランティアの受け入れ
サンプリング方法
調査対象母集団
説明
Group 1
Inclusion for Alabama site:
- 18 years of age or older
- Currently using or eligible for PrEP
Inclusion for Botswana site:
- 18 years of age or older
- Participated in the parent Tshireletso study in Botswana
Exclusion for both sites:
- Under the age of 18
- HIV positive
Group 2
Inclusion for both sites:
- 18 years of age or older
- Currently working as PrEP providers or clinic administrators at outpatient clinics
Exclusion for both sites:
- Under the age of 18
Group 3
Inclusion for both sites:
- 18 years of age or older
- Currently working as policy makers or program leaders at outpatient clinics
Exclusion for both sites:
- Under the age of 18
研究計画
研究はどのように設計されていますか？
デザインの詳細
コホートと介入
グループ/コホート |
介入・治療 |
|---|---|
|
Group 1: Adults Using or Eligible for PrEP
PrEP users - Individuals aged 18 years or older who are currently using or eligible for PrEP
|
No intervention
|
|
Group 2: PrEP Providers and Clinic Administrators
PrEP providers and clinic administrators - Individuals aged 18 years or older who work as PrEP providers or clinic administrators at outpatient clinics or inpatient settings
|
No intervention
|
|
Group 3: Policy Makers and Program Leaders
Policy makers and program leaders - Individuals aged 18 years or older who work as policy makers or program leaders at outpatient clinics or inpatient settings
|
No intervention
|
この研究は何を測定していますか？
主要な結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
PrEP Continuation (Aim 2)
時間枠：Up to 2 years
|
Among participants who initiate PrEP, to determine the proportion who continue PrEP use over 2 years.
|
Up to 2 years
|
二次結果の測定
結果測定 |
メジャーの説明 |
時間枠 |
|---|---|---|
|
PrEP Initiation (Aim 1)
時間枠：Within 2 years after the initial PrEP clinic visit
|
To determine the number and proportion of participants in the PrEP clinic who initiate PrEP.
|
Within 2 years after the initial PrEP clinic visit
|
|
PrEP Switching (Aim 3)
時間枠：Up to 2 years
|
Among participants who initiate PrEP, to determine the number and proportion who switch between PrEP modalities.
|
Up to 2 years
|
|
PrEP Discontinuation (Aim 4)
時間枠：Up to 2 years
|
Among participants who initiate PrEP, to determine the number and proportion who discontinue PrEP.
|
Up to 2 years
|
協力者と研究者
協力者
捜査官
- 主任研究者：Rena Patel, MD, MPH, MPhil、University of Alabama at Birmingham
- 主任研究者：Rebecca Zash、Division of Infectious Disease Beth Israel Deaconess Medical Center
研究記録日
主要日程の研究
研究開始 (推定)
一次修了 (推定)
研究の完了 (推定)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (実際)
学習記録の更新
投稿された最後の更新 (実際)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
本研究に関する用語
キーワード
追加の関連 MeSH 用語
その他の研究ID番号
- IRB-300016575
- R01AI155052 (米国 NIH グラント/契約)
個々の参加者データ (IPD) の計画
個々の参加者データ (IPD) を共有する予定はありますか?
医薬品およびデバイス情報、研究文書
米国FDA規制医薬品の研究
米国FDA規制機器製品の研究
米国で製造され、米国から輸出された製品。
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。