BEGIN:VCALENDAR VERSION:2.0 PRODID:Linklings LLC BEGIN:VTIMEZONE TZID:America/Chicago X-LIC-LOCATION:America/Chicago BEGIN:DAYLIGHT TZOFFSETFROM:-0600 TZOFFSETTO:-0500 TZNAME:CDT DTSTART:19700308T020000 RRULE:FREQ=YEARLY;BYMONTH=3;BYDAY=2SU END:DAYLIGHT BEGIN:STANDARD TZOFFSETFROM:-0500 TZOFFSETTO:-0600 TZNAME:CST DTSTART:19701101T020000 RRULE:FREQ=YEARLY;BYMONTH=11;BYDAY=1SU END:STANDARD END:VTIMEZONE BEGIN:VEVENT DTSTAMP:20240325T185833Z LOCATION:Salon A-3 DTSTART;TZID=America/Chicago:20240325T103000 DTEND;TZID=America/Chicago:20240325T105200 UID:HFESHCS_2024 International Symposium on Human Factors and Ergonomics i n Health Care_sess121_INDLEC123@linklings.com SUMMARY:“People Are Not Thinking About HIV Anymore:” Process Design for Pe diatricians and Adolescents to Support Human Immunodeficiency Virus Testin g and Preexposure Prophylaxis DESCRIPTION:Oral Presentations\n\nDean Karavite, Haley Richardson, Jessica Hopkins, Liz Odunaiya, and Naomi Pressman (Children's Hospital of Philade lphia) and Sarah Wood (Children's Hospital of Philadelphia; Perelman Schoo l of Medicine, University of Pennsylvania)\n\nBACKGROUND AND SIGNIFICANCE: \n\nDespite the disproportionate burden of Human Immunodeficiency Virus ( HIV) in adolescents and young adults, uptake of HIV testing and pre-exposu re prophylaxis (PrEP) remains suboptimal. The United States Preventative S ervices Task Force and Centers for Disease Control and Prevention guidelin es endorse universal HIV testing and PrEP counseling. [1] However, only 9% of U.S. high school students have been HIV tested, and <1% of PrEP prescr iptions are for minor adolescents.[2] HIV prevention service delivery also suffers from striking health inequities, with disparate rates of HIV test ing and PrEP prescription by race, sex, and sexual orientation. [3,4] \n\n Pediatric primary care visits are a window of opportunity for sexually tra nsmitted infection (STI) and HIV screening, and based on results, delivery of effective interventions such as PrEP. Yet sexual health service delive ry in pediatric primary care is hampered by limited time and a lack of ped iatrician comfort with sexual health discussions. In these busy settings, high provider mental workload can also result in biased decision making. D eveloping strategies for pediatricians to follow existing guidelines, equi tably and efficiently, for HIV prevention services could help address low screening rates and disparities in PrEP prescribing.\n\nMETHODS: \n\nWe ar e performing a sociotechnical analysis of pediatric primary care involving the diagnosis and treatment of STIs with a focus on HIV testing and PrEP counseling and prescribing. Data collection is being achieved via semi-str uctured interviews of up to forty primary care providers, forty adolescent patients, and other pediatric primary care clinicians and staff. Particip ant recruitment is from a network of 31 primary care practices focusing on practices with patient populations more likely to experience inequities. The provider interview script is based on the presentation and walkthrough of a realistic scenario of a patient presenting with a STI and the subseq uent potential workflows and outcomes involving HIV testing, and PrEP coun seling and prescribing. The interview guide was developed to capture infor mation based on the Systems Engineering Initiative for Patient Safety (SEI PS) 2.0 model to capture factors describing the work domain, processes, an d outcomes. [5] Following the scenario discussion, provider interview part icipants are asked to evaluate the potential effectiveness of potential in terventions including automated lab result messaging, text messaging to ad olescent patients, and a dedicated PrEP Navigator who would manage PrEP co unseling. Interviews are audio recorded and transcribed. The transcripts a re analyzed using a rapid qualitative analysis method also known as the “s ort and sift, think and shift” approach, to efficiently yield action-orien ted findings.[6] Initial coding templates capture relevant data regarding barriers and facilitators at each stage of the workflow for the outcomes o f HIV testing and PrEP. These data are then organized into a matrix, to al low for identification of key themes from within the SEIPS model, and addi tional novel themes. \n\nRESULTS: \n\nProvider interviews are in process, and adolescent interviews have just begun at the time of this submission, but with nine provider interviews complete, at least four broad themes are emerging. 1) Education: Providers are aware of PrEP and have positive att itudes toward it but are unfamiliar with guidelines on recommending and pr escribing PrEP, would value provider education delivered through multiple channels to accommodate their availability, and to be given easy access to trustworthy information resources and tools. 2) Time and Workload: Provid ers repeatedly discussed time and workload constraints within an adolescen t well or sick visit and the difficulties in arranging adolescent follow-u p visits, in person, phone, or tele-visit, for HIV testing and PrEP. 3) C onfidentiality: Participants discussed challenges, limitations, confusion, and concerns on how the electronic health record protects or fails to pro tect, adolescent privacy in multiple scenarios involving test results, doc umentation, and prescribing. 4) Resources. Providers interviewed to date r epresented 4 practices, 3 urban, 1 suburban, and even between the urban pr actices, presented a diverse range of practice personnel resources and pro cesses that could be applied to PrEP counseling and prescribing.\n\nProvid er responses to the potential interventions were consistent. For automated messages, providers felt they could be useful, but alone were inadequate in addressing all the challenges in HIV testing and PrEP counseling and pr escribing. In response to text messaging directed at adolescents, provider s were optimistic but deferred to direct study of adolescents on this topi c. Providers responded positively to a PrEP Navigator and felt that the mo st optimal solution would be to distribute tasks to a navigator-type role and the most appropriate and available clinicians and staff. Potential sol utions involve a distributed workflow where the provider would make genera l decisions and recommendations on HIV testing and PrEP, but have addition al tasks performed by a PrEP navigator, a nurse practitioner trained in Pr EP, nursing, and/or patient service representatives. In these discussions, several potential workflow options were discussed including options for r emote interaction with the patient for PrEP counseling, and the various co mmunication and documentation channels required to support a distributed w orkflow. All participants spoke of the need to interview adolescents and d iscussed many challenges including their ability to attend follow-up visit s, challenges in protecting confidentiality, specifically issues with the EHR, and finding ways to utilize adolescent preferences for communication and use of technology. Providers described a range of sociotechnical facto rs represented by differences between practices that included the availabi lity of personal resources, processing of labs, and provider education and knowledge access.\n\nDISCUSSION: \n\nOur results to date demonstrate that , from a provider perspective, developing EHR-based tools alone, including alerts and guideline-based clinical decision support interventions, are i nsufficient to contribute to improved outcomes in the delivery of PrEP cou nseling and prescriptions to adolescents given complexities related to pro vider educational needs, patient confidentiality, and the adolescent visit workflow. Instead, our results, derived though a sociotechnical approach, indicate a much more extensive and versatile process design that supports alternate workflows to accommodate differences in practice resources, pro vider knowledge, and confidentiality protections. This process design incl udes supporting providers with multi-modal education content, distributing and coordinating tasks between providers, nurses, staff, and developing a range of integrated EHR tools for documentation and communication tools t o support an extensive multi-role workflow. Of course, it will be critical to map these potential processes to the preferences of adolescents, but e arly results indicate providers support a versatile, dynamic, and distribu ted process where workflow and tasks are coordinated between clinicians an d staff.\n\nREFERENCES: \n\n1. Centers for Disease Control and Prevention. Preexposure Prophylaxis for the Prevention of HIV Infection in the United States- 2021 Update. Department of Health and Human Services, Centers for Disease Prevention and Control. https://www.cdc.gov/hiv/pdf/risk/prep/cdc -hiv-prep-guidelines-2021.pdf. Published 2021. Accessed 2022.\n\n2. Magnus on DH, T.; Mera, R. Adolescent Use of Truvada (FTC/TDF) for HIV Pre-Exposu re Prophylaxis (PrEP) in the United States: (2012-2017). 22nd Internationa l AIDS Conference; 2018; Amsterdam, Netherlands.\n\n3. Petsis D, Min J, Hu ang YV, Akers AY, Wood S. HIV Testing Among Adolescents with Acute Sexuall y Transmitted Infections. Pediatrics. 2020;145(4).\n\n4. Watson DL, Shaw P A, Petsis DT, et al. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexua lly transmitted infections in the United States, 2014-2019. J Int AIDS Soc . 2022;25(2):e25867.\n\n5. Holden RJ, Carayon P, Gurses AP, et al. SEIPS 2 .0: A human factors framework for studying and improving the work of healt hcare professionals and patients. Ergonomics. 2013;56(11). doi:10.1080/001 40139.2013.838643\n\n6. Maietta, R., Mihas, P., Swartout, K., Petruzzelli, J., & Hamilton, A. B. (2021). Sort and Sift, Think and Shift: Let the Dat a Be Your Guide An Applied Approach to Working With, Learning From, and Pr ivileging Qualitative Data. Qualitative Report, 26(6).\n\nTrack: Patient S afety Research and Initiatives\n\nSession Chair: Joseph Nuamah (Oklahoma S tate University) END:VEVENT END:VCALENDAR