Effect of a clinical decision support system on early action on immunological treatment failure in patients with HIV in Kenya: a cluster randomised controlled trial

Details

• Alternative Title:
  Lancet HIV
• Personal Author:
  Oluoch, Tom ; Katana, Abraham ; Kwaro, Daniel ; Santas, Xenophon ; Langat, Patrick ; Mwalili, Samuel ; Muthusi, Kimeu ; Okeyo, Nicky ; Ojwang, James K ; Cornet, Ronald ; Abu-Hanna, Ameen ; de Keizer, Nicolette
• Description:
  Background
  
  A clinical decision support system (CDSS) is a computer program that applies a set of rules to data stored in electronic health records to offer actionable recommendations. We aimed to establish whether a CDSS that supports detection of immunological treatment failure among patients with HIV taking antiretroviral therapy (ART) would improve appropriate and timely action.
  
  Methods
  
  We did this prospective, cluster randomised controlled trial in adults and children (aged ≥18 months) who were eligible for, and receiving, ART at HIV clinics in Siaya County, western Kenya. Health facilities were randomly assigned (1:1), via block randomisation (block size of two) with a computer-generated random number sequence, to use electronic health records either alone (control) or with CDSS (intervention). Facilities were matched by type and by number of patients enrolled in HIV care. The primary outcome measure was the difference between groups in the proportion of patients who experienced immunological treatment failure and had a documented clinical action. We used generalised linear mixed models with random effects to analyse clustered data. This trial is registered with ClinicalTrials.gov, number NCT01634802.
  
  Findings
  
  Between Sept 1, 2012, and Jan 31, 2014, 13 clinics, comprising 41 062 patients, were randomly assigned to the control group (n=6) or the intervention group (n=7). Data collection at each site took 12 months. Among patients eligible for ART, 10 358 (99%) of 10 478 patients were receiving ART at control sites and 10 991 (99%) of 11 028 patients were receiving ART at intervention sites. Of these patients, 1125 (11%) in the control group and 1342 (12%) in the intervention group had immunological treatment failure, of whom 332 (30%) and 727 (54%), respectively, received appropriate action. The likelihood of clinicians taking appropriate action on treatment failure was higher with CDSS alerts than with no decision support system (adjusted odds ratio 3.18, 95% CI 1.02–9.87).
  
  Interpretation
  
  CDSS significantly improved the likelihood of appropriate and timely action on immunological treatment failure. We expect our findings will be generalisable to virological monitoring of patients with HIV receiving ART once countries implement the 2015 WHO recommendation to scale up viral load monitoring.
  
  Funding
  
  US President’s Emergency Plan for AIDS Relief (PEPFAR), through the US Centers for Disease Control and Prevention.
  
  
• Keywords:
  Adolescent Adult Anti-HIV Agents CD4 Lymphocyte Count Child Child, Preschool Decision Support Systems, Clinical Delivery Of Health Care Drug Administration Schedule Female HIV Infections Humans Infant Kenya Male Prospective Studies Treatment Failure Viral Load

  More +
• Source:
  Lancet HIV. 3(2):e76-e84
• Pubmed ID:
  26847229
• Pubmed Central ID:
  PMC4777604
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHSUnited States/ ; U01 GH000048/GH/CGH CDC HHSUnited States/ ; GH000048-04/GH/CGH CDC HHSUnited States/ ; PEPFARUnited States/
• Place as Subject:
  Kenya
• Volume:
  3
• Issue:
  2
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:7cd9bc081aff7cf04bf44d427f6d0a40f63ef553e5f4e09a2cffc8938d0b1a78
• Download URL:
  https://stacks.cdc.gov/view/cdc/38338/cdc_38338_DS1.pdf
• File Type:
  [PDF - 770.72 KB ]