Randomized trial of online, interactive decision-support versus guidelines for HIV treatment selection by trainees

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Clinical Infectious Diseases

Support for clinicians in HIV medicine is critical given national HIV-provider shortages. Department of Health and Human Services (DHHS) guidelines are comprehensive but complex to apply for antiretroviral therapy (ART) selection. HIV-ASSIST (www.hivassist.com) is a free tool providing ART decision-support that could augment implementation of clinical practice guidelines.

We conducted a randomized study of medical students and residents at Johns Hopkins University, in which participants were asked to select an ART regimen for 10 HIV case-scenarios through an electronic survey. Participants were randomized to receive either DHHS guidelines alone (with video tutorial), or DHHS guidelines and HIV-ASSIST (with video tutorial) to support their decision-making. ART selections were graded ‘appropriate’ if consistent with DHHS guidelines, or concordant with regimens selected by HIV experts at four academic institutions.

Among 118 trainees, participants randomized to receive HIV-ASSIST had significantly higher percentage of appropriate ART selections compared to those receiving DHHS guidelines alone (% appropriate responses in DHHS vs HIV-ASSIST arms: median 40% [Q1, Q3: 30%, 50%] vs 90% [80%, 100%], p<0.001). This difference was consistent among both medical students (median 40% vs 90%, p<0.001) and residents (median 40% vs 90%, p<0.001). The effect was seen for all case-types, but most pronounced for complex cases involving ART-experienced patients with ongoing viremia (DHHS vs HIV-ASSIST: median 0% [0%, 33%] vs 100% [66%, 100%]).

Trainees using HIV-ASSIST were significantly more likely to choose appropriate ART regimens compared to those using guidelines alone. Interactive decision-support tools may be important to ensure appropriate implementation of HIV guidelines.

Ramirez JA, Maddali MV, Nematollahi S, Li JZ, Shah M. New Strategies in Clinical Guideline Delivery: Randomized trial of online, interactive decision-support versus guidelines for HIV treatment selection by trainees. Clin Infect Dis. 2020 Mar 25:ciaa299. doi: 10.1093/cid/ciaa299. Epub ahead of print. PMID: 32211758.