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.
연구 개요
상세 설명
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.
연구 유형
등록 (추정된)
연락처 및 위치
연구 연락처
- 이름: Rena Patel, MD, MPH
- 전화번호: +12059348145
- 이메일: renapatel@uabmc.edu
연구 장소
-
-
Gaborone
-
Bontleng, Gaborone, 보츠와나
- Princess Marina Hospital
-
연락하다:
- Bame Bame
- 전화번호: +267 72727347
- 이메일: bbame@bhp.org.bw
-
연락하다:
- Chelsea Morroni, MBChB, DFSRH, DTMH, MPhil, MP
- 전화번호: +267 765 24112
- 이메일: cmorroni@ed.ac.uk
-
-
참여기준
자격 기준
공부할 수 있는 나이
- 성인
- 고령자
건강한 자원 봉사자를 받아들입니다
샘플링 방법
연구 인구
설명
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
공부 계획
연구는 어떻게 설계됩니까?
디자인 세부사항
코호트 및 개입
그룹/코호트 |
개입 / 치료 |
|---|---|
|
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
|
연구는 무엇을 측정합니까?
주요 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
PrEP Continuation (Aim 2)
기간: Up to 2 years
|
Among participants who initiate PrEP, to determine the proportion who continue PrEP use over 2 years.
|
Up to 2 years
|
2차 결과 측정
결과 측정 |
측정값 설명 |
기간 |
|---|---|---|
|
PrEP Initiation (Aim 1)
기간: 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)
기간: 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)
기간: Up to 2 years
|
Among participants who initiate PrEP, to determine the number and proportion who discontinue PrEP.
|
Up to 2 years
|
공동 작업자 및 조사자
협력자
수사관
- 수석 연구원: Rena Patel, MD, MPH, MPhil, University of Alabama at Birmingham
- 수석 연구원: Rebecca Zash, Division of Infectious Disease Beth Israel Deaconess Medical Center
연구 기록 날짜
연구 주요 날짜
연구 시작 (추정된)
기본 완료 (추정된)
연구 완료 (추정된)
연구 등록 날짜
최초 제출
QC 기준을 충족하는 최초 제출
처음 게시됨 (실제)
연구 기록 업데이트
마지막 업데이트 게시됨 (실제)
QC 기준을 충족하는 마지막 업데이트 제출
마지막으로 확인됨
추가 정보
이 연구와 관련된 용어
추가 관련 MeSH 약관
기타 연구 ID 번호
- IRB-300016575
- R01AI155052 (미국 NIH 보조금/계약)
개별 참가자 데이터(IPD) 계획
개별 참가자 데이터(IPD)를 공유할 계획입니까?
약물 및 장치 정보, 연구 문서
미국 FDA 규제 의약품 연구
미국 FDA 규제 기기 제품 연구
미국에서 제조되어 미국에서 수출되는 제품
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