An HIV Pre-Exposure Prophylaxis (PrEP) Shared Decision-Making Tool
In anticipation of FDA approval of Long Acting Injectable (LAI) pre-exposure prophylaxis (PrEP), which occurred in December of 2021, a team of investigators from the George Washington Milken Institute School of Public Health (GWSPH) conducted a two-phase study to develop and pilot a tool to support people who might benefit from PrEP (PWBP) and their health care providers (HCP) in a process of PrEP shared decision-making. The study was funded by ViiV Healthcare and received Institutional Review Board (IRB) approval from GWSPH.
Access the Tools Here:
- Read about the Study
In the study’s first phase, the GWSPH team conducted one on one in depth interviews (IDIs) with a diverse sample of PWBP as well as PrEP HCPs to assess their awareness and initial perceptions of LAI PrEP and the kinds of information that would be important to include in a PrEP shared decision-making tool (SDT). Participants were recruited from two DC based Federally Qualified Health Centers that provide PrEP, Whitman Walker Institute (WWI) and La Clínica del Pueblo (LCDP). Interviews were recorded with participant permission, transcribed and coded for analysis. Key findings from both PWBP and HCP interviews were incorporated into a cross interview analytic matrix and provided the foundation for the creation of a PrEP SDT prototype which was also developed in Spanish.
In the study’s second phase, a diverse sample of PWBP and HCPs from WWI, LDCP and a University of North Carolina at Chapel Hill affiliated clinic, engaged in mock clinical encounters using the PrEP SDT prototype. Mock clinical encounters were typically conducted one on one in a private office within one of the study clinics although occasionally they took place virtually. HCP and PWBP were given access to the SDT in advance of the mock clinical encounter.
PWBP and HCP participants were each interviewed independently after the mock clinical encounter to assess their perspectives regarding the usability, utility, and feasibility of the PrEP SDT. Participants found the SDT acceptable and useful in addressing knowledge deficits and aiding PrEP decision making including with regards to PrEP modality options. The tool was found to be helpful to current, prior, and never PrEP users and those more and less knowledgeable about PrEP. Findings from exit interviews were synthesized into recommendations that guided a revision process aimed at improving the SDT’s clarity and effectiveness. Links to the final versions of the SDT are provided here in English and Spanish.
We are very grateful to ViiV Healthcare for their support of the study that led to the development of these tools and their willingness to make these PrEP SDTs available to all. The investigative team and its partners hope that you find this PrEP SDT of use.