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Patient-Led Decision-Making for HIV Preexposure Prophylaxis

  • Implementation Science (E Geng, Section Editor)
  • Published:
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Abstract

Purpose of Review

Shared decision-making is a process that involves bidirectional exchange of information between patients and providers to support patients in making individualized, evidence-based decisions about their healthcare. We review the evidence on patient-led decision-making, a form of shared decision-making that maximizes patient autonomy, as a framework for decisions about HIV preexposure prophylaxis (PrEP). We also assess the likelihood that patient-led decision-making occurs for PrEP and describe interventions to facilitate this process.

Recent Findings

Patient-led decision-making is likely to be uncommon for PrEP, in part because healthcare providers lack knowledge and training about PrEP. Few evidence-based interventions exist to facilitate patient-led decision-making for PrEP.

Summary

There is a need for rigorously developed interventions to increase knowledge of PrEP among patients and healthcare providers and support patient-led decision-making for PrEP, which will be increasingly important as the range of available PrEP modalities expands.

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Funding

This publication was made possible with the support from the Harvard University Center for AIDS Research, an NIH-funded program (P30 AI060354), the National Institute of Allergy and Infectious Diseases (K01 AI122853 to JLM), and Harvard Pilgrim Health Care Institute.

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Author notes

  1. Drs. Marcus and Krakower contributed equally to this work.

Authors and Affiliations

  1. Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Dr, Ste 401, Boston, MA, 02215, USA

    Whitney C. Sewell, Julia L. Marcus & Douglas S. Krakower

  2. Beth Israel Deaconess Medical Center, Division of Infectious Diseases, 110 Francis St., W/LMOB Suite GB, Boston, MA, 02215, USA

    Patricia Solleveld & Douglas S. Krakower

  3. Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA

    Dominika Seidman

  4. San Francisco General Hospital, 1001 Potrero Ave Ward 6D, San Francisco, CA, 94110, USA

    Dominika Seidman

  5. Family and Community Medicine, University of California, San Francisco, San Francisco General Hospital, 995 Potrero Avenue, Ward 83, San Francisco, CA, 94110, USA

    Christine Dehlendorf

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  1. Whitney C. Sewell
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Correspondence to Douglas S. Krakower.

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Conflict of Interest

Douglas Krakower has conducted research with project support from Gilead Sciences; has received honoraria for authoring or presenting continuing medical education content for Medscape, MED-IQ, and DKBMed; and has received royalties for authoring content for UpToDate, Inc. Julia Marcus has consulted for Kaiser Permanente Northern California on a research grant from Gilead Sciences. Whitney Sewell, Patricia Solleveld, Christine Dehlendorf and Dominika Seidman declare no conflicts.

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All reported studies with human subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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Sewell, W.C., Solleveld, P., Seidman, D. et al. Patient-Led Decision-Making for HIV Preexposure Prophylaxis. Curr HIV/AIDS Rep 18, 48–56 (2021). https://doi.org/10.1007/s11904-020-00535-w

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