Clinical decision support systems to guide healthcare providers on HIV testing. (1st July 2022)

• Record Type: Journal Article
• Authors: Smit, Mikaela; Jordans, Carlijn C.E.; Reinhard, Jitte M.; Bramer, Wichor M.; Verbon, Annelies; Rokx, Casper; Calmy, Alexandra
• Is Part Of: AIDS. Volume 36:Number 8(2022)
• Page Start: 1083
• Page End: 1093
• Publication Date: 2022-07-01
• Subjects: clinical decision support systems -- HIV diagnosis -- HIV testing -- meta-analyses -- systematic review; AIDS (Disease) -- Periodicals; Acquired Immunodeficiency Syndrome; AIDS (Disease); Periodicals; Periodicals; 616.9792005
• DOI: 10.1097/QAD.0000000000003211
• Languages: English
• ISSNs: 0269-9370

Abstract

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 = 3) of 2.57 [95% confidence interval (CI) 1.53–4.33, random-effect model] and in nonhospital settings ( n = 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.