A feasibility study for a clinical decision support system prompting <scp>HIV</scp> testing

Chadwick,; Hall, Christopher; Rae, Caroline; Rayment, Ml; Branch, Marian; Littlewood, J M; Sullivan, Ann

doi:10.1111/hiv.12472

Cited by 22 publications

(23 citation statements)

References 12 publications

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“…There were eight studies using clinical decision‐making tools to aid providers in identifying populations that should be tested for HIV. A variety of tools were developed: addition of HIV tests to the blood test ‘set’ requests or checklist , computer prompts for higher risk populations and risk assessments . Where recorded, the above interventions were successful at increasing testing .…”

Section: Resultsmentioning

confidence: 99%

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

et al. 2019

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Objectives Despite the availability of HIV testing guidelines to facilitate prompt diagnosis, late HIV diagnosis remains high across Europe. The study synthesizes recent evidence on HIV testing strategies adopted in health care settings in the European Union/European Economic Area (EU/EEA). Methods Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed and systematic searches were run in five databases (2010–2017) to identify studies describing HIV testing interventions in health care settings in the EU/EEA. The grey literature was searched for unpublished studies (2014–2017). Two reviewers independently performed study selection, data extraction and critical appraisal. Results One hundred and thirty intervention and/or feasibility studies on HIV testing in health care settings were identified. Interventions included testing provision (n = 94), campaigns (n = 14) and education and training for staff and patients (n = 20). HIV test coverage achieved through testing provision varied: 2.9–94% in primary care compared to 3.9–66% in emergency departments. HIV test positivity was lower in emergency departments (0–1.3%) and antenatal services (0–0.05%) than in other hospital departments (e.g. inpatients: 0–5.3%). Indicator condition testing programmes increased HIV test coverage from 3.9–72% before to 12–85% after their implementation, with most studies reporting a 10–20% increase. There were 51 feasibility and/or acceptability studies that demonstrated that HIV testing interventions were generally acceptable to patients and providers in health care settings (e.g. general practitioner testing acceptable: 77–93%). Conclusions This review has identified several strategies that could be adopted to achieve high HIV testing coverage across a variety of health care settings and populations in the EU/EEA. Very few studies compared the intervention under investigation to a baseline, but, where this was assessed, data suggested increases in testing.

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Section: Resultsmentioning

confidence: 99%

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

et al. 2019

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“…As use of EMRs is increasing within Australia's healthcare services, further studies should investigate the impact of a Clinical Decision Support System within the EMR to prompt HIV testing. [32][33][34] There are multiple limitations of this study. First, the data extraction process relied on accurate and comprehensive documentation of diagnoses in the discharge summaries by clinicians and accurate application of ICD-10 codes to discharge summary diagnoses by clerical staff.…”

Section: Discussionmentioning

confidence: 95%

“…Such prompts have the potential to increase testing and thus diagnose HIV at earlier stages. As use of EMRs is increasing within Australia's healthcare services, further studies should investigate the impact of a Clinical Decision Support System within the EMR to prompt HIV testing …”

Section: Discussionmentioning

confidence: 99%

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

King

Seah

Cheng

et al. 2020

Internal Medicine Journal

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Background In Australia, one‐third of human immunodeficiency virus (HIV) diagnoses occur late, with an estimated 11% of people with HIV unaware of their diagnosis. Undiagnosed and untreated HIV infection increases morbidity in the HIV positive person and allows onward transmission of HIV. Aim To determine the rate of HIV testing in acute general medicine patients with HIV indicator conditions (IC) and evaluate the effectiveness of an educational intervention in improving testing rates. Methods Single‐centre, tertiary hospital, before‐after study of general medicine inpatients with IC for 12 weeks prior and 10 weeks post an educational intervention focusing on recommendations for HIV testing including IC. The REASON Cohort Discovery Tool was used to search for the IC using ICD‐10 codes and laboratory data. The presence of IC was estimated, and HIV testing rates before and after the intervention were compared. Regression analysis was utilised to identify characteristics associated with HIV testing. Results Of 1414 admissions in the baseline period and 946 in the post‐period, 161 (11.4%) and 132 (14.0%) had at least one IC present respectively. There were 18 (11.2%) HIV tests performed for admissions with IC in the pre‐period which increased to 27 (20.5%) (P = 0.028) in the post‐period. Younger patients were more likely to be tested and regression analysis identified the educational intervention (adjusted odds ratio) 2.2 (1.1, 4.4) to be significantly associated with testing. Conclusions Although HIV testing rates for IC doubled following the intervention, they remained unacceptably low. The recently introduced electronic medical record presents opportunities to prompt HIV testing.

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“…Routine offer to all attendees to health care settings is likely to increase uptake and yield of previously undiagnosed persons at an earlier stage of infection. There is evidence that rate of provider offer could be increased through education of medical staff, particularly junior doctors and medical students , or the use of electronic testing prompts and clinical decision‐making tools .…”

Section: Discussionmentioning

confidence: 99%

Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland

et al. 2018

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A feasibility study for a clinical decision support system prompting HIV testing

Abstract: Using a CPOE-based clinical decision support application to prompt HIV testing appears both feasible and acceptable to HCWs. Refining the application to provide more accurate risk stratification is likely to make it more effective.

Cited by 22 publications

References 12 publications

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

HIV testing strategies employed in health care settings in the European Union/European Economic Area (EU/EEA): evidence from a systematic review

Missed opportunities for HIV testing persist despite a single educational intervention: how can we close this evidence‐practice gap?

Where do we diagnose HIV infection? Monitoring new diagnoses made in nontraditional settings in England, Wales and Northern Ireland

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