Clinical Decision Support Systems Increase HIV Screening

The Community Preventive Services Task Force (CPSTF) recommends the use of clinical decision support systems (CDSS) to increase HIV screening. A systematic review of evidence from 23 studies shows CDSS increase HIV screening for the general population and for persons at higher risk for HIV infection. Patients who test positive for HIV can be linked to care and treatment which would be expected to reduce HIV transmission.

Compared with no intervention, CDSS increased HIV screening and identified more HIV infections. The percent of patients tested for HIV increased by a median of 10.3 percentage points, and the number of patients who tested positive each month increased by a median of 1.3.

What are Clinical Decision Support Systems?

CDSS encompass a variety of tools such as computerized alerts and reminders to enhance decision making about patient care. To increase HIV screening, CDSS use patient data and current clinical guidelines to identify those eligible for HIV screening and send healthcare providers computerized alerts or reminders to order tests.

CDC guidelines recommend routine screening for all patients aged 13-64 years and all pregnant women, and at least annual screening for persons at high risk for HIV. Risk is assessed based on patients’ or their partners’ sexually transmitted disease diagnosis, sexual behavior, or history of injection drug use.

Patients may receive information about HIV transmission and testing prior to screening, and healthcare providers may receive education about HIV transmission, patient eligibility for screening, and how to correctly use CDSS.

Current use of electronic medical records (EMR) and electronic health records (EHR) in the United States is very high. This could make it easier for healthcare providers to adopt an additional alert for HIV screening (CPSTF).

Why is this important?

Ending the HIV Epidemic: A Plan for America is the operational plan developed by agencies across the U.S. Department of Health and Human Services (DHHS) to pursue the goal to reduce new HIV infections by 75% in 5 years and 90% in 10 years. The National Strategic Plan: A Roadmap to End the Epidemic for the United States, 2021-2025 (The Plan), also developed by DHHS, is closely aligned with, and complements, the Ending the HIV Epidemic. The Plan covers the entire United States with a focus on collaboration between all sectors of society to prevent new HIV transmission, improve health outcomes of people with HIV, and reduce HIV-related disparities and health inequities. Testing for HIV is the first step for both plans. Identifying interventions that increase HIV screening, especially among population groups with the highest rates of diagnosis, can facilitate testing.

For More Information:

• The Community Guide
  • Intervention Summary
  • One Pager – Clinical Decision Support Systems to Increase HIV Screening
  • HIV, STIs and Teen Pregnancy topic page
• CDC, HIV
  • Ending the HIV Epidemic: A Plan for America
  • America’s HIV Epidemic Analysis Dashboard (AHEAD)
• The National Strategic Plan: A Roadmap to End the Epidemic for the United States, 2021-2025