Designing a Shared Decision-Making Tool to Improve PrEP Initiation Among Black Sexual Minority Men
PrEP initiation must be substantially improved among young Black sexual minority men (SMM) to meet the goals of the Ending the HIV Epidemic (EHE) Plan for 2030. However, multilevel factors such as intersectional stigma, medical mistrust, problematic patient-clinician communication, and low perceived HIV risk (PHR) remain substantial PrEP initiation barriers for this group. Clinicians and researchers are typically ineffective at increasing PrEP initiation among Black SMM because they rely upon screening guidelines that inadequately identify acute risks and have limited time to empower patients to make an informed decision. Peer change agents (PCAs) are clinical support staff who provide PrEP-related information, disclose experiences, and help young Black SMM initiate PrEP through shared decision-making. Shared decision-making tools increase patient empowerment and willingness to initiate treatment. Therefore, the goal of this CFAR pilot study is to design a shared decision-making tool that leverages the communication patterns of a PCA to increase PrEP initiation among Black SMM. To achieve study aims, we will begin by conducting conversation analysis of 20 scripts that affected PrEP referral interests between the PCA and Black SMM ages 25-34 from an PCA-based intervention to improve PHR and PrEP initiation (Specific Aim 1). We will identify the range of Black SMM's values, beliefs, goals, and preferences and examine patterns in the PCA's linguistic cues that affect willingness to accept a PrEP referral. We will then use the identified patterns to design a shared decision-making tool that will prepare Black SMM to discuss PrEP issues with a PCA and improve initiation (Specific Aim 2). We will refine the tool assessing feasibility, acceptability, and responsiveness to community needs among key stakeholders to enhance its rigor. Findings will be used to design an pilot intervention testing the preliminary impact of shared decision-making tool on PrEP initiation among Black SMM in an R34 application.