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.
CONCLUSIONS: 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.
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.
CONCLUSIONS: 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.
摘要：
背景：在美国，超过120万人感染艾滋病毒。这种疾病不成比例地影响与男性发生性关系的男性（MSM），有色人种,年轻人和年轻人，和变性人。暴露前预防（PrEP）是一种有效的HIV预防方法。两个初级保健提供者（PCP）都存在处方PrEP和阻止患者开始PrEP的障碍。
方法：本研究，MOST:PrEP,遵循多阶段优化策略(MOST)框架。目的是确定患者和PCP之间的多层次干预措施，以增加初级保健中的PrEP处方。首先,将通过焦点小组从提供者和患者那里获得反馈，然后,将纳入与干预组件交付的特定环境（提供者和个人水平）因素相关的建议。随后，将使用24阶乘设计进行严格的实验,重点关注PrEP起始的优先人群.提供商组件包括基于计算机的模拟培训和最佳实践警报。患者组件包括量身定制的PrEP教育视频和HIV风险评估。最后,将对实施干预部分的促进者和障碍进行定性检查。
结论：在本协议文件中，我们描述了第一个已知的医疗保健领域多水平MOST优化试验之一.干预组件将交付给大型医疗保健系统中的患者和提供者，基于结束流行病的艾滋病毒优先管辖权。如果有效,这种多层次的方法可以传播给其他大型医疗保健系统的提供者和患者，从而对艾滋病毒预防产生重大影响。
方法：本研究，MOST:PrEP,遵循多阶段优化策略(MOST)框架。目的是确定患者和PCP之间的多层次干预措施，以增加初级保健中的PrEP处方。首先,将通过焦点小组从提供者和患者那里获得反馈，然后,将纳入与干预组件交付的特定环境（提供者和个人水平）因素相关的建议。随后，将使用24阶乘设计进行严格的实验,重点关注PrEP起始的优先人群.提供商组件包括基于计算机的模拟培训和最佳实践警报。患者组件包括量身定制的PrEP教育视频和HIV风险评估。最后,将对实施干预部分的促进者和障碍进行定性检查。
结论：在本协议文件中，我们描述了第一个已知的医疗保健领域多水平MOST优化试验之一.干预组件将交付给大型医疗保健系统中的患者和提供者，基于结束流行病的艾滋病毒优先管辖权。如果有效,这种多层次的方法可以传播给其他大型医疗保健系统的提供者和患者，从而对艾滋病毒预防产生重大影响。
