Provider Consent to Screen

Att 5d_Provider Consent to Screen.pdf

[NCHHSTP] mChoice: Improving PrEP Uptake and Adherence among Minority MSM through Tailored Provider Training and Adherence Assistance in Two High Priority Settings

Provider Consent to Screen

OMB: 0920-1428

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mChoice Consent to Screen (Aim 3)
We are conducting the mChoice study to improve the overall pre-exposure prophylaxis
(PrEP) experience of providers and men who have sex with men (MSM) patients by
implementing evidence-based education and support tools in clinical settings; and to
increase our understanding of provider and patient factors that influence the choice of
PrEP regimen by MSM in New York City, NY and Birmingham, AL.
We are providing training to healthcare providers to improve knowledge of PrEP clinical
recommendations and enhance provider communication. The provider training will be
presented in the form of a video composed of three modules that can be paused and
continued at any time. This video will also include pre- and post-assessments to
measure the training’s usefulness and efficacy for advancing PrEP knowledge. The
provider training modules can be completed on the participant’s own schedule over the
course of six months. At the end of the six-month period, participants will be asked to
participate in an in-depth interview to assess the impact of the provider training.
Participants may also be asked to fill out a clinic assessment tool at the clinic where
they work every six months for a period of 36 months total. Participating providers will
be from one of four clinics between Birmingham, AL and New York, NY.
Interested in joining the study?
If so, please answer the questions that follow to see if you are eligible to participate. The
screening questions will take about 5-10 minutes to complete.
As part of the screener, we will ask you questions about your demographics and
profession. A risk of being screened is that the questions may make you uncomfortable.
Please remember you can stop the screener at any time.
Another risk of screening is the possibility of your information being shared in a way that
you did not intend. However, the study team has taken many steps to keep information
secure, including using encryption and other data safety practices. Information you
enter is confidential, will NOT be linked with your name, and will only be used for
research purposes.
You will not directly benefit from being screened. If you are found eligible to enroll in the
study, it is possible that you may benefit from enhanced support for PrEP provision as
provided by the intervention. It is also possible you may not directly benefit from study
participation, though your involvement would help us work toward our research goals to

IRB-AAAT8812 (Y02M05)
IRB Approval Date: 03/22/2023
For use until: 07/25/2023

improve PrEP clinical care. Your participation in this study will in no way affect your
employment at the clinic. All study participants will receive financial incentives to
support study participation.
If you have questions, or concerns, you may call the Principal Investigator, Dr. Rebecca
Schnall at (212) 342-6886 or our study office number at (212) 305-8198. If you have
questions or concerns about your rights as a research subject, you may contact the
University of Columbia Institutional Review Board (IRB) at (212) 305-5883 or by email to
[email protected].
Do you consent to be screened for this study?

IRB-AAAT8812 (Y02M05)
IRB Approval Date: 03/22/2023
For use until: 07/25/2023


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File Created2023-02-15

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