HIV
Conditions
Keywords
HIV, PrEP, pre-exposure prophylaxis, prevention, prediction model, clinical decision support
Brief summary
Scale-up of HIV preexposure prophylaxis (PrEP) is a key strategy of the U.S. initiative to end the HIV epidemic, but healthcare providers lack tools to support PrEP discussions and prescribing for patients likely to benefit. This research will evaluate whether integrating automated tools into electronic health records to help providers efficiently and equitably identify potential candidates for PrEP, discuss PrEP, and prescribe PrEP can improve PrEP initiation and persistence in safety-net community health centers. It will achieve this by conducting a stepped-wedge trial of a decision support tool with an embedded HIV prediction model to identify patients likely to benefit from PrEP. The intervention will be delivered to healthcare providers in 16 community health centers within the national OCHIN network.
Interventions
OTHERPredictive Analytics and Clinical Decision Support
The intervention will include automated EHR notifications to clinicians at 16 OCHIN community health centers about patients who are likely to benefit from PrEP. These patients will be identified by an HIV prediction model that was developed and validated during the pilot phase of this study using historical OCHIN EHR data. For patients above a preselected threshold of predicted HIV risk, clinicians will be notified at the point of care that the patient may benefit from PrEP and will be provided with EHR-based tools to support discussions and prescribing. The intervention will also include coaching on PrEP and the decision support tool, as well as project team support during the trial period.
Sponsors
National Institute of Mental Health (NIMH)
OCHIN, Inc.
Oregon Health and Science University
Harvard Pilgrim Health Care
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Delivery site saw at least 500 distinct patients in 2024 during in-person or telehealth visits * Delivery site had at least 10 new HIV diagnoses or positive HIV screening tests in 2023 * Delivery site provides primary care other than pediatrics, and the primary care department(s) were active on OCHIN Epic as of 1/1/2023
Exclusion criteria
* Delivery site specializing in HIV or STI care * Correctional facilities * Mobile sites * School-based health center sites
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| PrEP initation | 30 months | Proportion of patients above the prediction model risk threshold without a recently active PrEP prescription (within the prior 6 months) or prior HIV diagnosis who are prescribed PrEP during the study period. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| PrEP persistence | 30 months | Proportion of patients prescribed PrEP who persist on PrEP for 6 and 12 months, as measured by prescription refills ordered. |
Countries
United States
Outcome results
None listed