Accepted for/Published in: JMIR Research Protocols
Date Submitted: Oct 3, 2019
Date Accepted: Dec 10, 2019
Date Submitted to PubMed: Jun 4, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Protocol for developing and evaluating an HIV-testing intervention for primary care using a modified stepped wedged study design
ABSTRACT
Background:
Late HIV-diagnoses foster HIV-transmission and may nurture hidden HIV-epidemics. In Belgium, mathematical modelling indicates high prevalence of undiagnosed HIV-infections among men who have sex with men (MSM) of non-Belgian origin and among sub-Saharan African Migrants (SAM). Promotion of HIV-testing facilitates early diagnoses, but diagnostic opportunities are being missed in primary care. This protocol presents the conceptual development, implementation and evaluation of an HIV-testing intervention for Flemish general practitioners (GPs).
Objective:
The intervention study intends to enhance provider-initiated HIV-testing by GPs.
Methods:
Guided by a simplified intervention mapping approach, an evidence-based intervention was developed in collaboration guided by an interdisciplinary advisory board (AB). The intervention consists of an evidence-based tool (i.e. ‘HIV-testing advice for primary care’) to support GP’s in provider-initiated HIV testing. A mixed methods evaluation design is used: A modified stepped wedge design gradually compares two different intervention levels: (1) Online dissemination of the HIV-testing advice and (2) Dissemination with an additional group-level training. Both conditions are compared against a control level with no intervention. The effect of the intervention is measured applying Poisson regression on national surveillance data. Primary outcome is the number of HIV-diagnoses made by GPs. Secondary outcomes are: HIV diagnoses among groups at risk for undiagnosed HIV; distribution of new diagnoses by CD4-cell count; number of HIV-tests prescribed by GPs; rate of new diagnoses by number of HIV tests performed. To evaluate the implementation, GPs’ fidelity to the intervention, feasibility and acceptability are assessed through (online) surveys and in-depth telephone interviews.
Results:
Results are not yet available. The study is ongoing: data analysis will start after data collection will be completed in the end of October 2019.
Conclusions:
Results of the intervention study will provide useful information on the intervention’s effectiveness among Flemish GPs and can inform further development of official testing guidelines. Limitation of this real-life intervention approach are potential spill-over effects, delay in access to surveillance data and little detailed information on HIV-testing practices among GPs. Clinical Trial: ClinicalTrials.gov, Identifier: NCT04056156, August 14, 2019, Retrospectively registered
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.