One intervention that may help narrow the gap between less-experienced physicians and their experienced counterparts is the use of an online decision support tool to guide HIV treatment prescribing practices. One such tool, HIV-ASSIST, improves trainees’ selection of appropriate antiretroviral treatment, researchers reported in Clinical Infectious Diseases.
In the study, researchers presented 118 medical students and residents at Johns Hopkins University in Baltimore, Maryland, with 10 case vignettes each, and asked them to select an appropriate HIV regimen. The medications chosen were considered appropriate if they were consistent with U.S. treatment guidelines or matched those selected by HIV experts at four institutions. Participants were randomized to use HIV-ASSIST or rely only on the guidelines (n=56).
Overall, a median of 90% of those in the HIV-ASSIST arm selected appropriate antiretrovirals compared to 40% in the guidelines arm. The differential grew more stark as case complexity increased: For instance, in scenarios involving patients who were virally suppressed but had extensive drug resistance, the median of correct medication selection was 0% in the guidelines-only arm compared to 67% in the HIV-ASSIST arm.
While HIV-ASSIST should be widely disseminated to facilitate prescribing antiretroviral treatment, consultations with experienced HIV providers are still needed for complex cases, Armstrong cautioned in her commentary. This requires a reimbursement structure to sustain such support networks.
Furthermore, prescriptions are only part of HIV care, Armstrong noted. “Clinicians must also provide stigma-free, culturally and structurally competent care, be comfortable discussing sexual health with members of all communities, explore structural and societal barriers to care, such as lack of transportation, unstable housing and food insecurity, and navigate and coordinate complex health systems,” she wrote, adding that better training opportunities for HIV care beyond infectious disease physicians would also help.