Clinical decision support systems to guide healthcare providers on HIV testing

Abstract

Objective: To understand the impact of clinical decision support systems (CDSSs) on improving HIV testing and diagnosis.Design: An original global systematic review (PROSPERO Number: CRD42020175576) of peer-reviewed articles reporting on electronic CDSSs that generate triggers encouraging healthcare providers to perform an HIV test.Methods: Medline, Embase, Cochrane CENTRAL and CINAHL EBSCOhost were searched up to 17 November 2020 and reference lists of included articles were checked. Qualitative and quantitative syntheses (using meta-analyses) of identified studies were performed. Results:The search identified 1424 records. Twenty-two articles met inclusion criteria (19 of 22 non-HIV endemic settings); 18 clinical and four laboratory-driven reminders. Reminders promoted 'universal' HIV testing for all patients without a known HIV infection and no recent documented HIV test, or 'targeted' HIV testing in patients with clinical risk-factors or specific diagnostic tests. CDSSs increased HIV testing in hospital and nonhospital setting, with the pooled risk-ratio amongst studies reporting comparable outcome measures in hospital settings (n ¼ 3) of 2.57 [95% confidence interval (CI) 1.53-4.33, random-effect model] and in nonhospital settings (n ¼ 4) of 2.13 (95% CI 1.78-4.14, random effect model). Results of the clinical impact of CDSSs on HIV diagnosis were mixed. Conclusion:CDSSs improve HIV testing and may, potentially, improve diagnosis. The data support the broader study of CDSSs in low-and high prevalent HIV settings to determine their precise impact on UNAIDS goals to reach universal HIV testing and treatment coverage.

Mapping hematologists’ HIV testing behavior among lymphoma patients–A mixed-methods study

“…Such prompts may be especially helpful to prevent missed testing opportunities in cases where testing was not done right away. Previous research showed that electronic prompts may increase HIV testing, although their effect is often lost when deactivated [28]. Additionally, guideline recommendations are often not adhered to without additional efforts to increase awareness of, and agreement on such recommendations [29][30][31].…”

“…Kroon 25 , T.J.W. van de Laar 26;27 , F. Lauw28 , M.M. van Leeuwen 5 , K. Lettinga 29 , I. Linde 1 , D.S.E.…”

How much do we need electronic clinical decision support systems to select patients to perform HIV tests in clinical settings?

“…The systematic review by Smit et al [5] performs an interesting attempt to put order to what has been published on these alert systems (clinical decision support systems, CDSS) and to highlight their advantages and disadvantages.…”