Clinical Decision Support for PrEP

Summary

Scale-up of HIV preexposure prophylaxis (PrEP) is a key strategy of the federal initiative to end the HIV epidemic. However, healthcare providers lack tools to identify patients who are at increased risk for HIV infection and thus likely to benefit from PrEP. This pilot study will test the hypothesis that an electronic health record (EHR)-based clinical decision support system that incorporates an HIV risk prediction model can help providers identify patients at increased risk for HIV infection and improve PrEP prescribing in safety-net community health centers. The clinical decision support system will be implemented in the EHR at 2-3intervention clinics, while 2 control clinics will receive standard of care. The primary outcome is PrEP prescriptions. Other key metrics of PrEP-related care to be assessed include medication persistence, adherence to monitoring guidelines for PrEP, and rates of HIV/STI testing and diagnoses. The expected outcome is the foundation for a large-scale cluster randomized trial to test whether EHR-based clinical decision support tools for PrEP can improve PrEP prescribing and prevent new HIV infections in a national network of community health centers.

Conditions

• HIV Infections
• Preexposure Prophylaxis (PrEP)

Interventions

OTHER

Standard of care

Two control clinics will be selected based on a set of matching criteria, e.g., urbanity and the sex, race, and age distributions of the patient population. Control clinics will not participate in study activities.

OTHER

Clinical decision support for PrEP

Healthcare providers at 2 intervention clinics (total of approximately 60 providers anticipated) will be prompted by an EHR-based tool to discuss PrEP with patients whose demographics and clinical history indicate increased predicted HIV risk. Providers will be offered clinical decision support tools to guide sexual health discussions and support PrEP prescribing.

Sponsors & Collaborators

• OCHIN, Inc.

  collaborator OTHER

• Oregon Health and Science University

  collaborator OTHER

• National Institute of Mental Health (NIMH)

  collaborator NIH

• Beth Israel Deaconess Medical Center

  collaborator OTHER

• Harvard Pilgrim Health Care

  lead OTHER

Principal Investigators

• Julia Marcus, PhD · Harvard Pilgrim Health Care Institute

• Douglas Krakower, MD · Beth Israel Deaconess Medical Center

Study Design

Allocation

NON_RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

15 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2022-07-11

Primary Completion

2026-08-31

Completion

2027-08-31

Countries

• United States

Study Locations