Jackman Kevon-Mark P, Tilchin Carla, Wagner Jessica, Flinn Ryan E, Trent Maria, Latkin Carl, Ruhs Sebastian, Fields Errol L, Hamill Matthew M, Mahaffey Carlos, Greenbaum Adena, Jennings Jacky M
Division of Adolescent and Young Adult Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
Center for Child and Community Health Research, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, United States.
JMIR Form Res. 2023 Feb 24;7:e43550. doi: 10.2196/43550.
Gay, bisexual, and other sexual minority men have expressed the acceptability of patient portals as tools for supporting HIV prevention behaviors, including facilitating disclosure of HIV and other sexually transmitted infection (STI/HIV) laboratory test results to sex partners. However, these studies, in which Black or African American sexual minority men were undersampled, failed to determine the relationship of reported history of discussing HIV results with sex partners and anticipated willingness to disclose web-based STI/HIV test results using a patient portal.
Among a sample of predominantly Black sexual minority men, this study aimed to (1) determine preferences for patient portal use for HIV prevention and (2) test the associations between reported history of discussing HIV results and anticipated willingness to disclose web-based STI/HIV test results with most recent main and nonmain partners using patient portals.
Data come from audio-computer self-assisted interview survey data collected during the 3-month visit of a longitudinal cohort study. Univariate analysis assessed patient portal preferences by measuring the valuation rankings of several portal features. Multiple Poisson regression models with robust error variance determined the associations between history of discussing HIV results and willingness to disclose those results using web-based portals by partner type, and to examine criterion validity of the enhancing dyadic communication (EDC) scale to anticipated willingness.
Of the 245 participants, 71% (n=174) were Black and 22% (n=53) were White. Most participants indicated a willingness to share web-based STI/HIV test results with their most recent main partner. Slightly fewer, nonetheless a majority, indicated a willingness to share web-based test results with their most recent nonmain partner. All but 2 patient portal features were valued as high or moderately high priority by >80% of participants. Specifically, tools to help manage HIV (n=183, 75%) and information about pre- and postexposure prophylaxis (both 71%, n=173 and n=175, respectively) were the top-valuated features to include in patient portals for HIV prevention. Discussing HIV test results was significantly associated with increased prevalence of willingness to disclose web-based test results with main (adjusted prevalence ratio [aPR] 1.46, 95% CI 1.21-1.75) and nonmain partners (aPR 1.54, 95% CI 1.23-1.93).
Our findings indicate what features Black sexual minority men envision may be included in the patient portal's design to optimize HIV prevention, further supporting the criterion validity of the EDC scale. Efforts should be made to support Black sexual minority men's willingness to disclose STI/HIV testing history and status with partners overall as it is associated significantly with a willingness to disclose testing results digitally via patient portals. Future studies should consider discussion behaviors regarding past HIV test results with partners when tailoring interventions that leverage patient portals in disclosure events.
男同性恋者、双性恋者及其他性少数群体男性已表示患者门户网站作为支持艾滋病预防行为的工具是可接受的，包括便于向性伴侣披露艾滋病病毒及其他性传播感染（性传播感染/艾滋病病毒）检测结果。然而，这些研究中黑人或非裔美国性少数群体男性抽样不足，未能确定报告的与性伴侣讨论艾滋病检测结果的历史与预期使用患者门户网站披露基于网络的性传播感染/艾滋病病毒检测结果的意愿之间的关系。
在以黑人为主的性少数群体男性样本中，本研究旨在（1）确定用于艾滋病预防的患者门户网站使用偏好，以及（2）测试报告的与性伴侣讨论艾滋病检测结果的历史与预期使用患者门户网站向最近的主要和非主要伴侣披露基于网络的性传播感染/艾滋病病毒检测结果的意愿之间的关联。
数据来自一项纵向队列研究3个月随访期间收集的音频计算机辅助自我访谈调查数据。单变量分析通过测量几个门户网站功能的估值排名来评估患者门户网站偏好。具有稳健误差方差的多重泊松回归模型确定了按伴侣类型讨论艾滋病检测结果的历史与使用基于网络的门户网站披露这些结果的意愿之间的关联，并检验增强二元沟通（EDC）量表对预期意愿的标准效度。
在245名参与者中，71%（n = 174）为黑人，22%（n = 53）为白人。大多数参与者表示愿意与最近的主要伴侣分享基于网络的性传播感染/艾滋病病毒检测结果。表示愿意与最近的非主要伴侣分享基于网络的检测结果的参与者略少，但仍占多数。除2个患者门户网站功能外，超过80%的参与者将所有功能评为高或中等高度优先。具体而言，帮助管理艾滋病的工具（n = 183，75%）以及暴露前和暴露后预防信息（均为71%，分别为n = 173和n = 175）是艾滋病预防患者门户网站中最受重视的功能。讨论艾滋病检测结果与向主要伴侣（调整患病率比[aPR] 1.46，95%置信区间1.21 - 1.75）和非主要伴侣（aPR 1.54，95%置信区间1.23 - 1.93）披露基于网络的检测结果的意愿患病率增加显著相关。
我们的研究结果表明，黑人性少数群体男性设想患者门户网站设计中可能包含哪些功能以优化艾滋病预防，进一步支持了EDC量表的标准效度。应努力支持黑人性少数群体男性总体上向伴侣披露性传播感染/艾滋病病毒检测历史和状况的意愿，因为这与通过患者门户网站以数字方式披露检测结果的意愿显著相关。未来研究在定制利用患者门户网站进行披露事件的干预措施时，应考虑与伴侣讨论过去艾滋病检测结果的行为。
