Using an automated decision support tool to improve HIV prescribing: A feasibility study

The selection of antiretroviral therapy (ART) regimens for people living with HIV is complex and dependent on individual and clinician-perceived risk factors and preferences. The British HIV Association (BHIVA) advocates cost-effective prescribing and shared decision-making between patients and clinicians. We evaluated the acceptability and potential impact of a prototype multi-patient automated decision support tool (DST) for improving individualized, safe, and cost-effective prescribing.

We surveyed people living with HIV and clinicians regarding treatment preferences and the acceptability of a DST. We developed a DST to interpret electronic patient record data, using 2022 BHIVA guidelines to identify optimal ART switch options. This was applied to patients prescribed ART between June 2022 and May 2023 in the local HIV service, and potential cost savings were calculated.

Among people living with HIV, 86.7% (144/166) respondents were open to switching to more cost-effective ART. While 94% (15/16) of clinician respondents prioritized lower-cost treatments where possible, only 38% (6/16) reported knowing about ART costs. Regimen switch options were identified for 274 of 503 people living with HIV meeting the inclusion criteria. Overall, potential cost savings of 28.4% of total ART spend (£26630.25 per month) were calculated if all possible switches to the most cost-effective option identified by the DST were made.

A DST based on BHIVA recommendations and using routinely collected data may be acceptable to patients, useful to clinicians, and could provide significant cost savings. A substantial proportion of people living with HIV in our cohort were open to considering changing their ART based on cost effectiveness.