Doctoral Student Columbia University Mailman School of Public Health
Abstract Title
Developing a decision tool to help women choose between oral and long-acting injectable antiretroviral therapy (ART)
Abstract Authors
Tara McCrimmon; Lauren F. Collins; Victoria A. Shaffer; Maria L. Alcaide; Morgan M. Philbin
Author Affiliations
Columbia University, New York City; Emory University School, Atlanta; University of Missouri, Columbia; University of Miami, Miami; University of California San Francisco, San Francisco
Background
Long-acting injectable antiretroviral therapy (LAI ART) provides an effective alternative to daily oral regimens for HIV treatment. Decision tools increase patient knowledge and decision-making power; this makes them particularly useful for female patients, who have been shown to value involvement in medical decision-making. No decision tools currently exist to facilitate shared decision-making between oral and LAI ART for women with HIV and their treatment providers, and we know little about how providers perceive these tools.
Methods
We conducted 38 in-depth interviews with HIV medical and social service providers across six U.S. cities between September 2021 and March 2022. We asked providers how an oral-LAI ART decision tool could be integrated into decision-making processes within their clinic. We recorded and transcribed interviews; thematic content analysis identified key findings.
Results
Some providers asserted that they would make the best decisions for patients and did not need a decision aid tool. Others indicated that they would use such tools, describing them as “an additional burden, but a worthy burden.” Providers believed that decision tools saved time otherwise spent on patient education, helping them to “be more efficient”; others said that tools would help them “know what to ask” when questioning patients about structural barriers that may interfere with adherence. Only a minority of providers noted how decision tools could increase patient empowerment: “They would be able to advocate for themselves more”.
Conclusion(s)
As long-acting ART modalities are scaled up to advance HIV treatment and adherence, decision tools provide an opportunity to improve patient autonomy around ART modality choice and empower women living with HIV to engage in shared decision making with appropriate support. These tools must be carefully designed and implemented to encourage patient-provider dialogue and engagement in ART modality choice.