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

Area of Science:

• Medical Informatics
• Public Health
• Infectious Disease

Background:

• Undiagnosed HIV infection and late presentation remain significant global health challenges.
• Current HIV testing strategies have not fully overcome these persistent issues.

Purpose of the Study:

• To evaluate a prototype risk-based application designed to prompt HIV testing during routine blood tests.
• To assess the feasibility and acceptability of a clinical decision support tool for increasing HIV testing.

Main Methods:

• Modified two computer physician order entry (CPOE) systems with a prototype application to prompt HIV testing based on patient risk factors.
• Implemented the application in a London hospital and general practices for three months.
• Interviewed healthcare workers (HCWs) on usability and acceptability; compared HIV testing rates before and after implementation in general practices.

Main Results:

• The CPOE-based HIV testing prompt system was found to be usable and acceptable to hospital doctors, general practitioners, and nurse practitioners.
• Prompt timing within consultations presented some challenges for discussion and consent.
• In general practices, approximately 1 in 10 prompts were accepted, leading to a 6% increase in HIV testing rates over the study period.

Conclusions:

• A CPOE-based clinical decision support application is a feasible and acceptable method for prompting HIV testing among healthcare workers.
• Further refinement of the application for more accurate risk stratification is recommended to enhance its effectiveness in increasing HIV testing rates.