USING an electronic health record (EHR)-based intervention has been shown to increase pre-exposure prophylaxis (PrEP) use among patients of primary care physicians caring for people with HIV, in a new trial. According to Jonathan Volk, Kaiser Permanente San Francisco, California, USA, and his research team, many individuals who are at risk of acquiring HIV could benefit greatly from the use of PrEP, but are not accessing the treatment. This trial aimed to understand whether a clinical decision support intervention, alerting healthcare providers about upcoming visits with patients at high risk of acquiring HIV, could increase PrEP use.
The cluster randomised trial involved assigning primary care providers (PCP) to either usual care, or an intervention in which they received an EHR message with prompts to discuss HIV prevention and PrEP before upcoming visits, with patients whose predicted 3-year HIV risk was above a prespecified threshold. The study involved 121 PCPs having a total of 5,051 appointments with eligible patients, 2,580 of whom received usual care, and 2,471 of whom were treated with the EHR-based intervention.
Overall, Volk and team found no significant increase in PrEP initiation among patients treated according to the intervention, compared to those undergoing usual treatment (6.0% versus 4.5%; hazard ratio [HR]: 1.32; 95% confidence interval [CI]: 0.84–2.1). A significant difference was found, however, in interaction based on HIV PCP status. Patients of providers who care for people with HIV were more than twice as likely to initiate PrEP (HR: 2.59; 95% CI: 1.30–5.16). The intervention did not show any benefit in PrEP initiation among providers who do not regularly care for patients with HIV (HR: 0.89; 95% CI: 0.59–1.35).
The researchers concluded that identifying patients who might be at higher risk of acquiring HIV in important, and clinical decision support tools can help PCPs better treat patients. Volk added: “We found our intervention to be more effective with clinicians who have experience with caring for people with HIV, suggesting that a low-intensity, EHR-embedded intervention can improve PrEP provision among providers already familiar with PrEP, whereas more involved interventions are likely needed for primary care providers with less familiarity with PrEP and HIV care.”
