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. 2024 Aug:143:107599.
doi: 10.1016/j.cct.2024.107599. Epub 2024 Jun 6.

Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the multiphase optimization strategy (MOST) framework

Elizabeth Lockhart  1 , DeAnne Turner  2 , Kate Guastaferro  3 , Laura A Szalacha  4 , Herica Torres Alzate  5 , Stephanie Marhefka  6 , Bianca Pittiglio  7 , Megan Dekker  8 , Hsueh-Han Yeh  9 , Logan Zelenak  10 , Jeremy Toney  11 , Sean Manogue  12 , Brian K Ahmedani  13
Affiliations

Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the multiphase optimization strategy (MOST) framework

Elizabeth Lockhart et al. Contemp Clin Trials. 2024 Aug.

Abstract

Background: In the United States, over 1.2 million people are living with HIV. This disease disproportionately affects men who have sex with men (MSM), people of color, youth and young adults, and transgender individuals. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method. Barriers exist for both primary care providers (PCPs) to prescribe PrEP and prevent patients from initiating PrEP.

Methods: This study, MOST: PrEP, follows the multiphase optimization strategy (MOST) framework. The purpose is to identify a multi-level intervention among patients and PCPs to increase PrEP prescriptions in primary care. First, feedback will be obtained from providers and patients via focus groups, then, suggestions related to the context-specific (provider and individual level) factors of intervention component delivery will be incorporated. Subsequently, a rigorous experiment will be conducted using a 24 factorial design focusing on priority populations for PrEP initiation. Provider components include computer-based simulation training and a best practice alert. Patient components include a tailored PrEP educational video and HIV risk assessment. Finally, the facilitators and barriers to implementing the intervention components will be qualitatively examined.

Conclusion: In this protocol paper, we describe the one of the first known multilevel MOST optimization trial in healthcare. Intervention components are to be delivered to patients and providers in a large healthcare system, based in an HIV Ending the Epidemic priority jurisdiction. If effective, this multi-level approach could be disseminated to providers and patients in other large healthcare systems to make a significant impact on HIV prevention.

Keywords: Computer-based simulation; HIV; Implementation science; Multilevel; Multiphase optimization strategy; PrEP; Primary care.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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