Predictive Analytics and Clinical Decision Support to Improve PrEP Prescribing

N/AActive Not RecruitingNCT06805877

Harvard Pilgrim Health Care16 enrolled

Overview

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.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

PREVENTION

Masking

NONE

Enrollment

Conditions

HIV

Interventions

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.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

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

Locations (16)

Bay Area Community Health Liberty Clinic

Fremont, California, United States

Lifelong East Oakland Health Center

Oakland, California, United States

TrueCare Oceanside Family Medicine

Oceanside, California, United States

DAP Legacy

Palm Springs, California, United States

One Community Health Midtown Campus

Sacramento, California, United States

Southwest Community Health Center 968 Fairfield Avenue

Bridgeport, Connecticut, United States

Mercy Care Decatur Street

Atlanta, Georgia, United States

Siouxland Community Health Center Sioux City

Sioux City, Iowa, United States

Lynn Community Health Center 269 Union

Lynn, Massachusetts, United States

Mattapan Community Health Center Blue Hill

Mattapan, Massachusetts, United States

...and 6 more locations

Outcomes

Primary Outcomes

PrEP initation

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.

Time frame: 30 months

Secondary Outcomes

PrEP persistence

Proportion of patients prescribed PrEP who persist on PrEP for 6 and 12 months, as measured by prescription refills ordered.

Time frame: 30 months