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Zucker J, Castor D, Theodore D, Carnevale C, Osilama E, Archer N, Bonadonna L, Wadden E, Morley N, Huang S, Meyers K, Cohall A, Gordon P, Sobieszczyk ME. Get2PrEP2-A Provider Messaging Strategy to Improve PrEP Uptake: A Randomized Controlled Quality Improvement Project. Open Forum Infect Dis 2024; 11:ofae297. [PMID: 38911948 PMCID: PMC11191360 DOI: 10.1093/ofid/ofae297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction HIV preexposure prophylaxis (PrEP), a key strategy for preventing HIV transmission, requires awareness and access to PrEP services. Although all patients should be made aware of HIV PrEP; the diagnosis of bacterial sexually transmitted infections (STIs) is an important indicator of potential HIV PrEP need. In a previous evaluation of Get2PrEP (G2P), we found that an electronic medical record laboratory comments did not increase the frequency of PrEP discussions between patients and providers. In Get2PrEP2 (G2P2), we hypothesized that active, personalized messaging to providers about HIV PrEP would increase the documentation of PrEP discussions, referrals, and/or provision of HIV PrEP to individuals diagnosed with an STI. Methods G2P2 was a parallel 3-arm, unblinded, randomized controlled design. Participants were allocated 2:1 to intervention or control. Participants in the intervention arm were further allocated to receive provider messaging through the electronic medical record chat message or e-mail. Results The 191 randomized encounters resulted in a modest 7.8% (odds ratio, 1.078; confidence interval, 1.02-1.13) increase in documented PrEP discussions in intervention encounters versus none in the standard care group. There was no statistical difference by intervention modality. All documented discussions occurred in the outpatient or emergency department and were more frequent in women and those aged <25 years. Discussion An e-mail or electronic medical record chat message sent to providers of patients testing positive for an STI had a small but significant effect on documented patient-provider PrEP discussions. Further investigation is required to determine whether provider messaging can increase PrEP uptake among eligible patients and longer-term outcomes.
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Affiliation(s)
- Jason Zucker
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Delivette Castor
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
- Department of Epidemiology, Mailman School of Public Health, New York, New York, USA
| | - Deborah Theodore
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Caroline Carnevale
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Eshiemomoh Osilama
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | - Norman Archer
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- UCSF School of Medicine, San Francisco, California, USA
| | - Lily Bonadonna
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elena Wadden
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Nicholas Morley
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Simian Huang
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Kathrine Meyers
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
| | - Alwyn Cohall
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, New York, USA
| | - Peter Gordon
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
| | - Magdalena E Sobieszczyk
- Department of Medicine, Division of Infectious Diseases, Columbia University Irving Medical Center, New York, New York, USA
- HIV Prevention Program in the Comprehensive Health Program, Ambulatory Care Network West, NewYork-Presbyterian Hospital, New York, New York, USA
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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Irie WC, Calabrese SK, Mayer KH, Geng EH, Blackstock O, Marcus JL. Social and structural factors associated with interest in HIV preexposure prophylaxis among Black women in the United States. AIDS Care 2024; 36:672-681. [PMID: 38176016 PMCID: PMC10994725 DOI: 10.1080/09540121.2023.2299338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 12/18/2023] [Indexed: 01/06/2024]
Abstract
In a nationwide sample of cisgender Black women in the US, we assessed the associations between social and structural factors and interest in using HIV preexposure prophylaxis (PrEP). Among 315 respondents, 62.2% were interested in PrEP if it were provided for free. Positive social norms surrounding PrEP, including injunctive norms (perceived social acceptability of PrEP use) and descriptive norms (perceived commonality of PrEP use), were positively associated with interest in using PrEP. Concerns about HIV infection, recently visiting a health care provider, and comfort discussing PrEP with a provider were also positively associated with interest in using PrEP. Anticipating PrEP disapproval from others was negatively associated with interest in PrEP. Although PrEP can promote autonomy and personal discretion, Black women's PrEP-related decisions occur in a complex social environment. Black women may benefit from interventions to promote positive norms and attitudes surrounding PrEP at the community level and empower them in discussions with their providers about PrEP.
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Affiliation(s)
- Whitney C. Irie
- Boston College School of Social Work, Chestnut Hill, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Sarah K. Calabrese
- Department of Psychological and Brain Sciences, George Washington University, Washington, D.C., USA
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, D.C., USA
| | - Kenneth H. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, MA
| | - Elvin H. Geng
- Division of Infectious Diseases, Washington University in St Louis, St. Louis, MO, USA
| | | | - Julia L. Marcus
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
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Volk JE, Leyden WA, Lea AN, Lee C, Donnelly MC, Krakower DS, Lee K, Liu VX, Marcus JL, Silverberg MJ. Using Electronic Health Records to Improve HIV Preexposure Prophylaxis Care: A Randomized Trial. J Acquir Immune Defic Syndr 2024; 95:362-369. [PMID: 38412047 DOI: 10.1097/qai.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 12/07/2023] [Indexed: 02/29/2024]
Abstract
BACKGROUND Preexposure prophylaxis (PrEP) use remains limited and inequitable, and strategies are needed to improve PrEP provision in primary care. METHODS We conducted a cluster randomized trial at Kaiser Permanente, San Francisco, to evaluate the effectiveness of a clinical decision support intervention guided by an electronic health record (EHR)-based HIV risk prediction model to improve PrEP provision. Primary care providers (PCPs) were randomized to usual care or intervention, with PCPs who provide care to people with HIV balanced between arms. PCPs in the intervention arm received an EHR-based staff message with prompts to discuss HIV prevention and PrEP before upcoming in-person or video visits with patients whose predicted 3-year HIV risk was above a prespecified threshold. The main study outcome was initiation of PrEP care within 90 days, defined as PrEP discussions, referrals, or prescription fills. RESULTS One hundred twenty-one PCPs had 5051 appointments with eligible patients (2580 usual care; 2471 intervention). There was a nonsignificant increase in initiation of PrEP care in the intervention arm (6.0% vs 4.5%, HR 1.32, 95% CI: 0.84 to 2.1). There was a significant interaction by HIV provider status, with an intervention HR of 2.59 (95% CI: 1.30 to 5.16) for HIV providers and 0.89 (95% CI: 0.59 to 1.35) for non-HIV providers (P-interaction <0.001). CONCLUSION An EHR-based intervention guided by an HIV risk prediction model substantially increased initiation of PrEP care among patients of PCPs who also care for people with HIV. Higher-intensity interventions may be needed to improve PrEP provision among PCPs less familiar with PrEP and HIV care.
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Affiliation(s)
- Jonathan E Volk
- Department of Infectious Diseases, Kaiser Permanente San Francisco, San Francisco, CA
| | - Wendy A Leyden
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Alexandra N Lea
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Catherine Lee
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | | | - Douglas S Krakower
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Boston, MA; and
| | - Kristine Lee
- Department of Adult and Family Medicine, Kaiser Permanente San Francisco, San Francisco, CA
| | - Vincent X Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Julia L Marcus
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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