an ipad-based risk assessment tool for prep administration: opinions of msm

An iPad-Based Risk Assessment Tool for PrEP Administration: Opinions of MSM

Jeb JonesPatrick SullivanRob StephensonJennifer Taussig

Rollins School of Public Health, Emory University

August 17, 2011

Background

• Pre-exposure prophylaxis (PrEP)

• Providing HIV drugs to HIV-negative individuals to prevent HIV acquisition if exposed

• Clinical trial results • 44% effective in MSM with very high risk behavior

• How do we identify guys who might be candidates for PrEP?

Outline

• HIV Risk Screener

• Purpose of the screener

• Preparation for PrEP

• Benefits of an iPad-based screener

Outline

•Screenshots

•Focus group results

• Opinions of MSM – feasibility, usability, and acceptability of iPad-based screener

HIV Risk Screener

•Brief questionnaire

•Identify patient’s HIV-risk level•e.g., high vs. low

HIV Risk Screener

• Provide HIV prevention recommendations to physician/health care provider

• Allow for identification of high-risk patients who may be candidates of PrEP

• Based on reported risk behaviors and geography

• Epidemiologic importance of geography

HIV Risk Screener

•Based on a CDC draft screener

•Generated from a statistical model of risk factors for HIV among MSM

•Still in development – not a final version

HIV Risk Screener


•Provider can administer questions or can be self-administered by patient

• Can be difficult for health care providers to discuss sexual behavior – particularly with MSM

• Allows for patient discretion regarding sensitive issues

• Automated recommendations

HIV Risk Screener


• Easily transfer data to local computers

• No human transcription required

• Potential for inclusion of geographic data

• Incorporate local incidence and prevalence in risk algorithm

HIV Risk Screener

• FileMaker Pro (Mac OS 10.6)

• Powerful, user-friendly database software

• FMTouch

• Transfer and run FileMaker databases on iPods and iPads

HIV Risk Screener

• Summary

• Relatively short – 12 total questions

• Healthcare provider does not have to ask questions directly

HIV Risk Screener

• Summary

• Quickly provides clear, concise recommendations to healthcare provider

• Prompts healthcare provider to recommend prevention services regardless of risk level

• Intensive HIV prevention services, such as PrEP

• Less intensive HIV prevention services

HIV Risk Screener

•Summary

• iPad-based HIV Risk Screener

• Potentially more honest responses from patients if they self-administer

• Easily adjusted – add/delete questions, incorporate geographic information

Focus Group Discussions

• Three focus group discussions with MSM• HIV-negative

• Primary care visit within past 12 months

• Each participant was able to complete the iPad screener before we discussed their opinions

• Atlanta, GA• Group 1: 5 white MSM• Group 2: 9 black MSM

• Minneapolis, MN• Group 3: 10 white MSM

Focus Group Discussions

• Overall impressions

• Generally very positive reviews of iPad

• Receptive to using iPad-based risk screener

Themes from Focus Group Discussions

• All participants reported that they would be comfortable completing a sexual risk questionnaire on an iPad

• Particularly with a new provider or in a walk-in clinic

• Of those with a regular physician, most reported no questions about sexual health or behavior when they see their provider

• Participants in MN reported more frequent discussions of sexual behavior with their providers


•Might result in more honest responses

• Particularly for those uncomfortable discussing sexual issues with doctor

• “Other people would be more honest”

•More private than paper and pencil

• Some participants currently not open about their sexuality with their healthcare providers


• Might speed up the visit

• Prefer to complete the questionnaire in waiting room – don’t detract from time with physician

•Could “jog your memory” about things you want to discuss with physician


• Suggested more questions

• More drug/alcohol questions

• Types of partner – steady vs. casual, age of partner(s)

• Condom use

• Intentions of screener should not be clear

• Avoid people changing their answers to try to get PrEP


• Don’t want the screener to detract from interaction with physician

•Black MSM much more concerned about being singled-out by their healthcare providers based on sexual preference

• “You get it and then it’s like, ‘What, does my doctor think I’m gay?’”

• OK as long as everyone is asked to complete the screener


•Geographic questions

• Zip codes are insufficient metric – people only know their own zip code

• Need other methods for obtaining geographic data• Maps? Intersections?

•Provide immediate feedback based on responses

• Have option to email custom HIV-prevention information to patient

• Provide talking points to discuss with healthcare provider


• Summary

• Well received

• Focus group participants regarded iPad-based questionnaire as easy to use and a welcome technology

Future Directions

• Geographic data

• What metric will be most accurate?

• Is zip code level data attainable/necessary?

• Focus groups with primary care providers

• Other populations

• Intravenous drug users, high-risk heterosexuals

Acknowledgments

• Focus group participants• Patrick Sullivan1

• Rob Stephenson1

• Dawn Smith2

• Jennifer Taussig1

• Eli Rosenberg1

• Minnesota Department of Health• Peter Carr• Allison LaPointe• Theodore (Ted) Bonau

• Emory Center for AIDS Research (CFAR)• P30 AI050409

1Emory University, 2CDC Division of HIV/AIDS Prevention

Thank you!

an ipad-based risk assessment tool for prep administration: opinions of msm

Health & Medicine