An iPad-Based Risk Assessment Tool for PrEP Administration: Opinions of MSM                    Jeb Jones                 P...
Background• Pre-exposure prophylaxis (PrEP)  •   Providing HIV drugs to HIV-negative individuals to      prevent HIV acqui...
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 sc...
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 ...
HIV Risk Screener•Based on a CDC draft screener  •Generated from a statistical model of risk  factors for HIV among MSM  •...
HIV Risk Screener• Benefits of an iPad-based screener  •Provider can administer questions or can  be self-administered by ...
HIV Risk Screener• Benefits of an iPad-based screener  • Easily transfer data to local computers    •   No human transcrip...
HIV Risk Screener• FileMaker Pro (Mac OS 10.6)  •   Powerful, user-friendly database software• FMTouch  •   Transfer and r...
HIV Risk Screener• Summary • Relatively short – 12 total questions • Healthcare provider does not have to ask   questions ...
HIV Risk Screener• Summary • Quickly provides clear, concise   recommendations to healthcare provider • Prompts healthcare...
HIV Risk Screener•Summary • iPad-based HIV Risk Screener   •   Potentially more honest responses from patients if they    ...
Focus Group Discussions• Three focus group discussions with MSM  • HIV-negative  • Primary care visit within past 12 month...
Focus Group Discussions• Overall impressions  • Generally very positive reviews of iPad  • Receptive to using iPad-based r...
Themes from Focus Group Discussions• All participants reported that they would be  comfortable completing a sexual risk  q...
Themes from Focus Group Discussions•Might result in more honest responses  • Particularly for those uncomfortable discussi...
Themes from Focus Group Discussions• Might speed up the visit  • Prefer to complete the questionnaire in waiting room – do...
Themes from Focus Group Discussions• Suggested more questions  • More drug/alcohol questions  • Types of partner – steady ...
Themes from Focus Group Discussions• Don’t want the screener to detract from  interaction with physician•Black MSM much mo...
Themes from Focus Group Discussions•Geographic questions  • Zip codes are insufficient metric – people only know their    ...
Themes from Focus Group Discussions• Summary • Well received • Focus group participants regarded iPad-   based questionnai...
Future Directions• Geographic data  • What metric will be most accurate?  • Is zip code level data attainable/necessary?• ...
Acknowledgments   •     Focus group participants   •     Patrick Sullivan1   •     Rob Stephenson1   •     Dawn Smith2   •...
Thank you!
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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An iPad-Based Risk Assessment Tool for PrEP Administration: Opinions of MSM

  1. 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. 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. 3. Outline• HIV Risk Screener • Purpose of the screener • Preparation for PrEP • Benefits of an iPad-based screener
  4. 4. Outline•Screenshots•Focus group results • Opinions of MSM – feasibility, usability, and acceptability of iPad-based screener
  5. 5. HIV Risk Screener•Brief questionnaire•Identify patient’s HIV-risk level •e.g., high vs. low
  6. 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. 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. 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. 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. 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. 11. HIV Risk Screener• Summary • Relatively short – 12 total questions • Healthcare provider does not have to ask questions directly
  12. 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. 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. 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. 15. Focus Group Discussions• Overall impressions • Generally very positive reviews of iPad • Receptive to using iPad-based risk screener
  16. 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. 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. 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. 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. 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. 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. 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. 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. 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. 25. Thank you!

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