1. An iPad-Based Risk Assessment Tool for
PrEP Administration: Opinions of MSM
Jeb Jones
Patrick Sullivan
Rob Stephenson
Jennifer Taussig
Rollins School of Public Health, Emory University
August 17, 2011

2. Background
• Pre-exposure prophylaxis (PrEP)
• Providing HIV drugs to HIV-negative individuals to
prevent HIV acquisition if exposed
• Clinical trial results
• 44% effective in MSM with very high risk behavior
• How do we identify guys who might be candidates for
PrEP?

3. Outline
• HIV Risk Screener
• Purpose of the screener
• Preparation for PrEP
• Benefits of an iPad-based screener

4. Outline
•Screenshots
•Focus group results
• Opinions of MSM – feasibility, usability,
and acceptability of iPad-based screener

5. HIV Risk Screener
•Brief questionnaire
•Identify patient’s HIV-risk level
•e.g., high vs. low

6. HIV Risk Screener
• Provide HIV prevention recommendations to
physician/health care provider
• Allow for identification of high-risk patients
who may be candidates of PrEP
• Based on reported risk behaviors and geography
• Epidemiologic importance of geography

7. HIV Risk Screener
•Based on a CDC draft screener
•Generated from a statistical model of risk
factors for HIV among MSM
•Still in development – not a final version

8. HIV Risk Screener
• Benefits of an iPad-based screener
•Provider can administer questions or can
be self-administered by patient
• Can be difficult for health care providers to discuss
sexual behavior – particularly with MSM
• Allows for patient discretion regarding sensitive
issues
• Automated recommendations

9. HIV Risk Screener
• Benefits of an iPad-based screener
• Easily transfer data to local computers
• No human transcription required
• Potential for inclusion of geographic data
• Incorporate local incidence and prevalence in risk
algorithm

10. HIV Risk Screener
• FileMaker Pro (Mac OS 10.6)
• Powerful, user-friendly database software
• FMTouch
• Transfer and run FileMaker databases on iPods and
iPads

19. HIV Risk Screener
• Summary
• Relatively short – 12 total questions
• Healthcare provider does not have to ask
questions directly

20. HIV Risk Screener
• Summary
• Quickly provides clear, concise
recommendations to healthcare provider
• Prompts healthcare provider to recommend
prevention services regardless of risk level
• Intensive HIV prevention services, such as PrEP
• Less intensive HIV prevention services

21. HIV Risk Screener
•Summary
• iPad-based HIV Risk Screener
• Potentially more honest responses from patients if they
self-administer
• Easily adjusted – add/delete questions, incorporate
geographic information

22. Focus Group Discussions
• Three focus group discussions with MSM
• HIV-negative
• Primary care visit within past 12 months
• Each participant was able to complete the iPad screener
before we discussed their opinions
• Atlanta, GA
• Group 1: 5 white MSM
• Group 2: 9 black MSM
• Minneapolis, MN
• Group 3: 10 white MSM

23. Focus Group Discussions
• Overall impressions
• Generally very positive reviews of iPad
• Receptive to using iPad-based risk screener

24. Themes from Focus Group Discussions
• All participants reported that they would be
comfortable completing a sexual risk
questionnaire on an iPad
• Particularly with a new provider or in a walk-in clinic
• Of those with a regular physician, most reported
no questions about sexual health or behavior
when they see their provider
• Participants in MN reported more frequent discussions of
sexual behavior with their providers

25. Themes from Focus Group Discussions
•Might result in more honest responses
• Particularly for those uncomfortable discussing sexual
issues with doctor
• “Other people would be more honest”
•More private than paper and pencil
• Some participants currently not open about their sexuality
with their healthcare providers

26. Themes from Focus Group Discussions
• Might speed up the visit
• Prefer to complete the questionnaire in waiting room – don’t
detract from time with physician
•Could “jog your memory” about things you want
to discuss with physician

27. Themes from Focus Group Discussions
• Suggested more questions
• More drug/alcohol questions
• Types of partner – steady vs. casual, age of partner(s)
• Condom use
• Intentions of screener should not be clear
• Avoid people changing their answers to try to get PrEP

28. Themes from Focus Group Discussions
• Don’t want the screener to detract from
interaction with physician
•Black MSM much more concerned about being
singled-out by their healthcare providers based
on sexual preference
• “You get it and then it’s like, ‘What, does my doctor think I’m
gay?’”
• OK as long as everyone is asked to complete the screener

29. Themes from Focus Group Discussions
•Geographic questions
• Zip codes are insufficient metric – people only know their
own zip code
• Need other methods for obtaining geographic data
• Maps? Intersections?
•Provide immediate feedback based on
responses
• Have option to email custom HIV-prevention information to
patient
• Provide talking points to discuss with healthcare provider

30. Themes from Focus Group Discussions
• Summary
• Well received
• Focus group participants regarded iPad-
based questionnaire as easy to use and a
welcome technology

31. Future Directions
• Geographic data
• What metric will be most accurate?
• Is zip code level data attainable/necessary?
• Focus groups with primary care providers
• Other populations
• Intravenous drug users, high-risk heterosexuals

32. Acknowledgments
• Focus group participants
• Patrick Sullivan1
• Rob Stephenson1
• Dawn Smith2
• Jennifer Taussig1
• Eli Rosenberg1
• Minnesota Department of Health
• Peter Carr
• Allison LaPointe
• Theodore (Ted) Bonau
• Emory Center for AIDS Research (CFAR)
• P30 AI050409
1Emory University, 2CDC Division of HIV/AIDS Prevention

33. Thank you!