A Multilevel, Multiphase Optimization Strategy for PrEP (MOST:PrEP)

Conditions

• HIV Seropositivity

Eligibility Criteria

Sex

ALL

Age

18 Years - N/A

Healthy Volunteers

Accepted

Interventions

• Computer-based simulation training for providers — BEHAVIORAL
  A Computer-Based Simulation training for providers, based on the Centers for Disease Control and Prevention "Guide for Healthcare Professional: Discussing Sexual Health with Your Patients", current PrEP information, and the Social Cognitive Theory. This is a single-session, 30-minute training module contains educational information with animated narration about PrEP, how to take a sexual health history, understanding internal bias, potential patient barriers to PrEP as well as recorded video-simulated encounters, in which providers view different types of patient/provider interactions.
• Best Practice Alert — BEHAVIORAL
  A Best Practice Alert will alert providers to patients who are part of the Centers for Disease Control and Prevention PrEP priority populations.
• HIV Risk Assessment — BEHAVIORAL
  A risk assessment tool that considers the behaviors - i.e., types of sexual activities, protective behaviors (condoms, PrEP, ART), and other factors (HIV status, sexually transmitted infections) of the respondent.
• PrEP Informational Video — BEHAVIORAL
  A short informational video, tailored to the local Detroit context with themes that will focus on introducing PrEP, stigma surrounding taking PrEP, and potential barriers and how to overcome them.

Study Details

What is known: There are 1.2 million people in the US who meet the indications for PrEP; yet, disparities exist in uptake. For example, only 9% of Black and 16% of Latino individuals, compared to 65% of White individuals, have been prescribed PrEP. At Henry Ford Health (HFH) system, only 10% of eligible patients have been prescribed PrEP. Primary care is an ideal setting for PrEP to be offered as an HIV prevention method since providers see large numbers of patients who are HIV negative, with some who are at increased risk for HIV, and the primary care setting is often the point of entry to the healthcare system. The multiphase optimization strategy (MOST) framework is a novel, innovative way to identify an efficient intervention. What will be done: In this optimization trial, the investigators will test the effectiveness of intervention components, alone and in combination, on new PrEP prescriptions in primary care at HFH. First, feedback will be generated on context-specific (system and individual level) factors for intervention component delivery via focus groups with providers (n=15) and patients eligible for PrEP (n=30). Then, four intervention components will be tested in an optimization trial, with 16 conditions being implemented at 32 clinics. Finally, feedback will be generated on the factors that affected implementation via semi-structured interviews with providers (n=30) and patients (n=30). Participants will be primary care providers (PCPs) and patients eligible for PrEP in Henry Ford Health System. Clinics will be randomized (yes/no) to receive any combination of provider and patient intervention components. Provider intervention components include computer-based simulation training and/or best practice alerts delivered via the electronic health record (EHR). Patient intervention components include HIV risk assessment and/or PrEP informational video - both delivered via the EHR. Primary outcome is the rate of new PrEP prescriptions at the clinic level. Secondary outcomes will include PrEP maintenance, number of HIV tests ordered by a PCP, and number of PCPs trained. Sub analyses will test which factors moderate (e.g., patient sex, race, age, gender, sexual orientation) or mediate (e.g., perceived HIV risk, provider and patient PrEP knowledge) PrEP uptake, focusing on priority populations and disparities in rates of PrEP prescription. Implications: 1) Understanding which intervention components lead to increased PrEP prescriptions will represent an important advance in HIV prevention efforts. 2) Optimizing a multi-level intervention for providers and patients to increase PrEP prescriptions would lead to a new, efficient, evidence-based option. 3) Determining what factors are related to PrEP uptake will help reduce disparities in PrEP initiation among those most in need. 4) Understanding the context specific factors related to intervention component implementation will help identify best methods for replication/adaptation in other healthcare systems.

Key Dates

Start date

Feb 21, 2024

Status verified

May 2025

Primary completion

Apr 30, 2028

Completion

Apr 30, 2028

Study Design

Enrollment

1,380 participants (estimated)

Allocation

RANDOMIZED

Intervention model

FACTORIAL

Primary purpose

PREVENTION

Arms

• No Intervention: No intervention
  No intervention
• Experimental: Video
  Patient PrEP Video only
• Experimental: Risk Assessment
  Patient Risk Assessment only
• Experimental: Risk Assessment and Video
  Patient Risk Assessment and Patient PrEP Video
• Experimental: Best Practice Alert
  Best Practice Alert only
• Experimental: Best Practice Alert and Video
  Best Practice Alert and Patient PrEP Video
• Experimental: Best Practice Alert and Risk Assessment
  Best Practice Alert and Patient Risk Assessment
• Experimental: Best Practice Alert, Risk Assessment and Video
  Best Practice Alert, Patient Risk Assessment, and Patient PrEP Video
• Experimental: Training
  Provider Training
• Experimental: Training and Video
  Provider Training and Patient PrEP Video
• Experimental: Training and Risk Assessment
  Provider Training and Patient Risk Assessment
• Experimental: Training, Risk Assessment, and Video
  Provider Training, Patient Risk Assessment, and Patient PrEP Video
• Experimental: Training and Best Practice Alert
  Provider Training and Best Practice Alert
• Experimental: Training, Best Practice Alert, and Video
  Provider Training, Best Practice Alert, and Patient PrEP Video
• Experimental: Training, Best Practice Alert, and Risk Assessment
  Provider Training, Best Practice Alert, and Patient Risk Assessment
• Experimental: Training, Best Practice Alert, Risk Assessment, and Video
  Provider Training, Best Practice Alert, Patient Risk Assessment, and Patient PrEP Video

Primary Outcome Measure

Clinic-Level PrEP Prescription [ Time Frame: Year 1 and Year 5 electronic health record data pull. ]

Locations (1)

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