Informing and promoting Shared decision making for HIV Prevention and Alcohol Reduction: Engaging Diverse Veterans to Refine and Pilot a Decision Aid (SHARE Study)
Project Number5R34AA030449-03
Contact PI/Project LeaderWILLIAMS, EMILY CATERINA Other PIs
Awardee OrganizationUNIVERSITY OF WASHINGTON
Description
Abstract Text
ABSTRACT
Preventing HIV transmission with enhanced Pre-exposure Prophylaxis (PrEP) access, particularly among
marginalized populations with disproportionate HIV incidence (e.g., minoritized racial/ethnic and sexual
orientation and gender groups), is a crucial step in ending the HIV epidemic. Though unhealthy alcohol use is a
central modifiable risk factor for HIV incidence and over-represented among marginalized populations, few HIV
prevention interventions exist that synergistically address both unhealthy alcohol use and PrEP. Research is
needed to understand PrEP uptake among individuals with unhealthy alcohol use and to develop scalable
patient-centered interventions that synergistically address unhealthy alcohol use and HIV. The Veterans Health
administration (VA) is a leader in provision of evidence-based care for unhealthy alcohol use, yet substantial
gaps in PrEP implementation for Veterans with unhealthy alcohol use exist—our preliminary research suggests
major gaps in PrEP knowledge, use, and reach, and Veterans with unhealthy alcohol use. Evidence-based
interventions/treatments are available for unhealthy alcohol use, but alcohol use is historically under targeted in
HIV prevention interventions. Our team of interdisciplinary experts in HIV and addiction medicine, the intersection
of alcohol use and HIV, implementation science, health disparities research, and community-partnered research
will use sequential mixed methods guided by socioecological theory, the Consolidated Framework for
Implementation Science, and the Discover/Design/Build/Test (DDBT) process to understand the impact of
unhealthy alcohol use on the PrEP care continuum and then refine an existing decision aid to increase PrEP
initiation in primary care at the point of alcohol-related care in the VA. Quantitative work will include ~1.9 million
individuals, including adequate numbers of minoritized patients (e.g., ~115,000 individuals with minoritized
sexual orientation and ~11,000 individuals with minoritized gender identity) and will assess variation in patterns
of PrEP initiation and persistence across VA facilities and patient subgroups (Aim 1). Findings will be used to
inform purposive sampling for qualitative work to refine (Aim 2) and then pilot test an existing decision aid for
developed previously with NIAAA support (Aim 3). Our study is patient-centered and innovative in characterizing
PrEP care overall and within diverse subgroups of patients with and without unhealthy alcohol use, leveraging a
novel natural language processing (NLP)--driven algorithm for identifying sexual minority groups, and tailoring
an existing decision aid to facilitate shared decision-making for co-occurring HIV prevention and alcohol use.
Study activities will be conducted with iterative input from a community advisory board. The study is highly
responsive to NIAAA priorities and has potential for high impact as it will lay foundation for integrating a patient-
centered and multi-targeted novel decision aid for HIV prevention in routine primary care settings that may have
potential to increase equity in care.
Public Health Relevance Statement
NARRATIVE
Optimizing pre-exposure Prophylaxis (PrEP) access is crucial for ending the HIV epidemic, particularly among
marginalized populations; though unhealthy alcohol use is a central modifiable risk factor for HIV incidence, few
HIV prevention interventions exist that synergistically address both. Research is needed to understand PrEP
uptake among individuals with unhealthy alcohol use and to develop scalable patient-centered interventions
that synergistically address unhealthy alcohol use and HIV. The proposed sequential mixed methods study will
use co-design methodology, guided by a Community Advisory Board, in nation’s largest provider of both HIV
and alcohol-related care to examine PrEP initiation and persistence among patients with unhealthy alcohol use,
including those from marginalized subgroups, and tailor and pilot a decision aid to foster shared decision-
making to enhance uptake of PrEP concomitantly with provision of evidence-based alcohol-related care.
NIH Spending Category
No NIH Spending Category available.
Project Terms
AIDS preventionAddressAdultAlcohol consumptionAlcoholsAlgorithmsAttentionBehaviorCaringConsolidated Framework for Implementation ResearchContinuity of Patient CareDataDecision AidDecision MakingDiscover, Design, Build, and Test FrameworkElectronic Health RecordEligibility DeterminationEpidemicEquityEthnic OriginEvidence based interventionFoundationsGenderGender IdentityGeographic LocationsHIVHealthHealth Disparities ResearchHearingIncidenceIndividualInterventionInterviewKnowledgeMedicineMethodologyMethodsMinorityModelingNational Institute on Alcohol Abuse and AlcoholismNatural Language ProcessingOutpatientsPatientsPatternPersonsPharmaceutical PreparationsPopulationPrimary CarePrimary Care PhysicianProcessProviderRaceRecommendationResearchRisk FactorsSafe SexSamplingSex OrientationSexual and GenderMinoritiesStigmatizationStructureSubgroupTestingUnited StatesVariantVeteransVeterans Health AdministrationViralVisitWorkaddictionalcohol abuse therapyalcohol misusecognitive interviewcommunity advisory boardcommunity engaged researchdesigndisorder preventionethnic identityevidence baseexperienceimplementation scienceimprovedinnovationmarginalizationmarginalized populationminority patientmodifiable risknovelpatient orientedpatient subsetspilot testpre-exposure prophylaxispreferencepreventpreventive interventionprimary care settingracial minorityracial minority populationrecruitsexual identitysexual minoritysexual minority groupshared decision makingtargeted treatmenttheoriestraditional caretransgendertransmission processtreatment as preventionuptakeusability
National Institute on Alcohol Abuse and Alcoholism
CFDA Code
273
DUNS Number
605799469
UEI
HD1WMN6945W6
Project Start Date
01-September-2022
Project End Date
31-August-2025
Budget Start Date
01-September-2024
Budget End Date
31-August-2025
Project Funding Information for 2024
Total Funding
$216,758
Direct Costs
$171,497
Indirect Costs
$45,261
Year
Funding IC
FY Total Cost by IC
2024
National Institute on Alcohol Abuse and Alcoholism
$216,758
Year
Funding IC
FY Total Cost by IC
Sub Projects
No Sub Projects information available for 5R34AA030449-03
Publications
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Outcomes
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No Outcomes available for 5R34AA030449-03
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