Developing and pilot testing an eHealth decision support tool for young people at risk of HIV to improve informed decision making about PrEP

Project Summary
Youth at risk of HIV in the US are less likely to be aware of, use, or adhere to PrEP. This is especially worrisome as new modalities beyond daily oral (i.e. injectable, longer acting pills) are quickly coming on the market, making decision making and clarifying preferences crucial to uptake. Importantly, missing in much of the research on barriers to PrEP uptake are the voices of young (15-24) people at risk for HIV, who may experience age-related barriers to PrEP decision making, such as confidentiality, conflicts with family, and lack of a supportive community with credible spokespeople whom they trust. No interventions have developed decision support tools (DSTs) to help youth at risk for HIV make decisions about PrEP in line with their individual preferences and values that meet youth where they are. The primary goal of this study is to develop and evaluate the feasibility, acceptability and promise of efficacy of an electronic health DST called QUEEN-P (QUestions to Empower and ENgage with PrEP) to increase PrEP informed decision making among youth at risk for HIV in Philadelphia. Using commercial marketing techniques – perceptual mapping and vector message modeling – and grounded in the Ottawa Decision Support Framework, QUEEN-P will be delivered via tablets or other devices in novel locations (mobile vans, events), working with community partners known to be trusted by youth. Specific aims are: 1. Assess perceptions of PrEP, different delivery methods and potential barriers to initiation and adherence. We will establish community and scientific advisory boards (CAB/SAB) made up of youth and healthcare providers and community advocates, interview youth (n=20) to assess barriers, survey youth (n=100) and use perceptual mapping analyses to develop targeted messages, and elicit feedback from the CAB/SAB on content and delivery of QUEEN-P; 2. Develop the QUEEN-P eHealth DST and assess usability and acceptability. We will develop a prototype DST and concept-test messages and features with our CAB/SAB for feedback on acceptability, revise it based on feedback and conduct user testing (n=20); 3. Pilot the intervention to assess for promise of efficacy in engaging youth at risk for HIV in PrEP informed decision making and assess interest in and outreach to community clinical partners for PrEP. We will conduct a pilot test (n=60) in Philadelphia with youth at risk for HIV randomized to an “Enhanced” (QUEEN-P + navigation to PrEP providers) or “Basic” study arm (basic PrEP information and a list of resources). To assess promise of efficacy, we will compare outreach to clinical partners and decisional conflict (primary outcomes) at 3-month follow-up and assess decision preparation, self-reported knowledge and attitudes, and PrEP uptake (secondary outcomes; immediate post, 3 month follow-up). Qualitative exit interviews will inform feasibility and acceptability. This pilot study will examine the potential impact of using technology-based interventions to improve PrEP informed decision making in a population at high risk of HIV acquisition.

Grant Number: 1R34MH137753-01
NIH Institute/Center: NIH
Principal Investigator: Sarah Bass