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

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  • 1. An iPad-Based Risk Assessment Tool for PrEP Administration: Opinions of MSM Jeb Jones Patrick Sullivan Rob Stephenson Jennifer Taussig Rollins School of Public Health, Emory University August 17, 2011
  • 2. 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?
  • 3. Outline• HIV Risk Screener • Purpose of the screener • Preparation for PrEP • Benefits of an iPad-based screener
  • 4. Outline•Screenshots•Focus group results • Opinions of MSM – feasibility, usability, and acceptability of iPad-based screener
  • 5. HIV Risk Screener•Brief questionnaire•Identify patient’s HIV-risk level •e.g., high vs. low
  • 6. 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
  • 7. 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
  • 8. HIV Risk Screener• Benefits of an iPad-based 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
  • 9. HIV Risk Screener• Benefits of an iPad-based 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
  • 10. HIV Risk Screener• FileMaker Pro (Mac OS 10.6) • Powerful, user-friendly database software• FMTouch • Transfer and run FileMaker databases on iPods and iPads
  • 11. HIV Risk Screener• Summary • Relatively short – 12 total questions • Healthcare provider does not have to ask questions directly
  • 12. 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
  • 13. 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
  • 14. 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
  • 15. Focus Group Discussions• Overall impressions • Generally very positive reviews of iPad • Receptive to using iPad-based risk screener
  • 16. 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
  • 17. Themes from Focus Group Discussions•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
  • 18. Themes from Focus Group Discussions• 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 wantto discuss with physician
  • 19. Themes from Focus Group Discussions• 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
  • 20. Themes from Focus Group Discussions• Don’t want the screener to detract from interaction with physician•Black MSM much more concerned about beingsingled-out by their healthcare providers basedon 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
  • 21. Themes from Focus Group Discussions•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 onresponses • Have option to email custom HIV-prevention information to patient • Provide talking points to discuss with healthcare provider
  • 22. Themes from Focus Group Discussions• Summary • Well received • Focus group participants regarded iPad- based questionnaire as easy to use and a welcome technology
  • 23. 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
  • 24. 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 AI0504091Emory University, 2CDC Division of HIV/AIDS Prevention
  • 25. Thank you!

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