Assessing the validity of a single-item HIV risk stage-of-change measure

Protocol for WeExPAnd: a prospective, mixed-methods pilot demonstration study to increase access to pre-exposure prophylaxis among women vulnerable to HIV infection in the Southern USA

INTRODUCTION

African American women (AA), particularly those living in the Southeastern USA, experience disproportionately high rates of HIV infection. Pre-exposure prophylaxis (PrEP) is a highly effective HIV prevention tool that may circumvent barriers to traditional HIV prevention tools, such as condom use; however, very little is known about how to improve PrEP access and uptake among AA women who may benefit from PrEP use. This project aims to understand how to increase PrEP access among AA women in the rural Southern USA, which may ultimately affect HIV incidence in this population.

METHODS AND ANALYSIS

The goal of the current study is to systematically adapt a patient-provider communication tool to increase PrEP uptake among AA women receiving care at a federally qualified health centre in Alabama. We will use an iterative implementation process, by assessing the feasibility, acceptability and preliminary impact of the tool on PrEP uptake, using a pilot preintervention/postintervention design (N=125). We will evaluate women's reasons for declining a referral to a PrEP provider, reasons for incomplete referrals, reasons for not initiating PrEP after a successful referral and ongoing PrEP use at 3 and 12 months after PrEP initiation among our sample. The proposed work will significantly contribute to our understanding of factors impacting PrEP uptake and use among AA women, particularly in underserved areas in the Deep South that are heavily impacted by the HIV epidemic and experience worse HIV-related health outcomes relative to other areas in the USA.

ETHICS AND DISSEMINATION

This protocol has been approved by the Institutional Review Board (IRB) at University of Alabama at Birmingham (Birmingham, AL; protocol 300004276). All participants will review a detailed informed consent form approved by the IRB and will provide written or verbal informed consent prior to enrolment. Results will be disseminated through peer-reviewed manuscripts, reports, and local, national and international presentations.

TRIAL REGISTRATION NUMBER

NCT04373551.

The Use of Single-Item Ratings Versus Traditional Multiple-Item Questionnaires to Assess Mood and Health

Collecting real-world evidence via ‘at home’ assessments in ambulatory patients or healthy volunteers is becoming increasingly important, both for research purposes and in clinical practice. However, given the mobile technology that is frequently used for these assessments, concise assessments are preferred. The current study compared single-item ratings with multiple-item subscale scores of the same construct, by calculating the corresponding Bland and Altman 95% limits of agreement interval. The analysis showed that single-item ratings are usually in good agreement with assessments of their corresponding subscale. In the case of more complex multimodal constructs, single-item assessments were much less often in agreement with multiple-item questionnaire outcomes. The use of single-item assessments is advocated as they more often incorporate assessments of all aspects of a certain construct (including the presence, severity, and impact of the construct under investigation) compared to composite symptom scores.