Do clinical decision-support reminders for medical providers improve isoniazid prescription rates among HIV-positive adults?

Abstract

People living with HIV (PLHIV) are at increased risk of developing active tuberculosis (TB) and dying from TB. Isoniazid (INH) preventive therapy (IPT) can prevent this but only a small fraction of HIV-positive individuals are on IPT. Previous research suggests that clinical decision support systems (CDSS)—electronic systems that use existing patient data and established algorithms to generate alerts reminders or recommendations intended to aid clinical decision making—have the potential to improve provider adherence to diagnostic and treatment guidelines. Researchers conducted a cluster randomized controlled trial of a new CDSS intervention for TB screening prevention and treatment in a high HIV and TB prevalence setting to evaluate the effects of implementing a reminder system for medical providers to increase IPT for PLHIV. Specifically the research objective was to determine if the intervention increases IPT prescription rates and decreases the time from initial encounter to IPT initiation. The study took place in western Kenya from April to November 2014. Facilities (clusters) rather than individual providers were randomized to the study arms to prevent potential contamination and spillover effects. Twenty public medical facilities (clusters) were sorted into four strata and randomly assigned to the intervention or control arm (ratio of 1:1). Medical facilities were recruited from the AMPATH network of clinics that serves a catchment area of 3.5 million people and cares for about 150000 HIV positive patients nearly half of whom are being treated for active TB. (excerpt)