Patient-Led Decision-Making for HIV Preexposure Prophylaxis

Whitney C Sewell¹, Patricia Solleveld², Dominika Seidman^{3

4}, Christine Dehlendorf⁵, Julia L Marcus¹, Douglas S Krakower^{6

7}

Affiliations

¹ Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA.
² Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA.
³ Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
⁴ San Francisco General Hospital, 1001 Potrero Ave Ward 6D, San Francisco, CA, 94110, USA.
⁵ Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, 995 Potrero Avenue, Ward 83, San Francisco, CA, 94110, USA.
⁶ Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA. dkrakowe@bidmc.harvard.edu.
⁷ Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA. dkrakowe@bidmc.harvard.edu.

PMID: 33417201
PMCID: PMC8086908
DOI: 10.1007/s11904-020-00535-w

Review

Patient-Led Decision-Making for HIV Preexposure Prophylaxis

Whitney C Sewell et al. Curr HIV/AIDS Rep. 2021 Feb.

. 2021 Feb;18(1):48-56.

doi: 10.1007/s11904-020-00535-w. Epub 2021 Jan 8.

Authors

Whitney C Sewell¹, Patricia Solleveld², Dominika Seidman^{3

4}, Christine Dehlendorf⁵, Julia L Marcus¹, Douglas S Krakower^{6

7}

Affiliations

¹ Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA.
² Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA.
³ Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
⁴ San Francisco General Hospital, 1001 Potrero Ave Ward 6D, San Francisco, CA, 94110, USA.
⁵ Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, 995 Potrero Avenue, Ward 83, San Francisco, CA, 94110, USA.
⁶ Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA. dkrakowe@bidmc.harvard.edu.
⁷ Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA. dkrakowe@bidmc.harvard.edu.

PMID: 33417201
PMCID: PMC8086908
DOI: 10.1007/s11904-020-00535-w

Abstract

Purpose of review: Shared decision-making is a process that involves bidirectional exchange of information between patients and providers to support patients in making individualized, evidence-based decisions about their healthcare. We review the evidence on patient-led decision-making, a form of shared decision-making that maximizes patient autonomy, as a framework for decisions about HIV preexposure prophylaxis (PrEP). We also assess the likelihood that patient-led decision-making occurs for PrEP and describe interventions to facilitate this process.

Recent findings: Patient-led decision-making is likely to be uncommon for PrEP, in part because healthcare providers lack knowledge and training about PrEP. Few evidence-based interventions exist to facilitate patient-led decision-making for PrEP. There is a need for rigorously developed interventions to increase knowledge of PrEP among patients and healthcare providers and support patient-led decision-making for PrEP, which will be increasingly important as the range of available PrEP modalities expands.

Keywords: Decision-support; Patient-led decision-making; Preexposure prophylaxis; Shared decision-making.

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Conflict of interest statement

Conflict of interest: Douglas Krakower has conducted research with project support from Gilead Sciences; has received honoraria for authoring or presenting continuing medical education content for Medscape, MED-IQ, and DKBMed; and has received royalties for authoring content for Uptodate, Inc. Julia Marcus has consulted for Kaiser Permanente Northern California on a research grant from Gilead Sciences. Whitney Sewell, Patricia Solleveld, Christine Dehlendorf and Dominika Seidman declare no conflicts.

References

1. Chou R, Evans C, Hoverman A, Sun C, Dana T, Bougatsos C, et al. Preexposure Prophylaxis for the Prevention of HIV Infection: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2019;321(22):2214–30. - PubMed
2. The United States Preventive Services Task Force issued a Grade A recommendation for the use of tenofovir disoproxil fumarate with emtricitabine as daily oral HIV preexposure prophylaxis (PrEP), indicating strong evidence of net clinical benefit for this regimen. This review summarizes the clinical evidence in support of the Grade A recommendation for PrEP, which can inform decision-support interventions for PrEP.
1. Volk JE, Marcus JL, Phengrasamy T, Blechinger D, Nguyen DP, Follansbee S, et al. No New HIV Infections With Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting. Clin Infect Dis. 2015;61(10):1601–3. - PMC - PubMed
1. Kanny D, Jeffries WLt, Chapin-Bardales J, Denning P, Cha S, Finlayson T, et al. Racial/Ethnic Disparities in HIV Preexposure Prophylaxis Among Men Who Have Sex with Men - 23 Urban Areas, 2017. MMWR Morb Mortal Wkly Rep. 2019;68(37):801–6. - PMC - PubMed
1. McFarland W, Lin J, Santos GM, Arayasirikul S, Raymond HF, Wilson E. Low PrEP Awareness and Use Among People Who Inject Drugs, San Francisco, 2018. AIDS Behav. 2019. - PubMed
2. This study of people who inject drugs in San Francisco found that only 57% had heard of PrEP, 14% had discussed PrEP with a provider, and 3% had used PrEP in the prior year, highlighting a need for interventions to improve knowledge, patient-provider discussions, and use of PrEP for this key population.
1. Finlayson T, Cha S, Xia M, Trujillo L, Denson D, Prejean J, et al. Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men - 20 Urban Areas, 2014 and 2017. MMWR Morb Mortal Wkly Rep. 2019;68(27):597–603. - PMC - PubMed

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Patient-Led Decision-Making for HIV Preexposure Prophylaxis

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Patient-Led Decision-Making for HIV Preexposure Prophylaxis

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