ABSTRACT
BACKGROUND:
Clinical decision support (CDS) is a promising intervention for improving uptake of
HIV testing and
pre-exposure prophylaxis (PrEP). However, little is known regarding provider perspectives on acceptability, appropriateness, and feasibility of CDS for
HIV prevention in pediatric
primary care, a key implementation setting.
METHODS:
This was a cross-sectional multiple
methods study utilizing surveys and in-depth interviews with
pediatricians to assess acceptability, appropriateness, and feasibility of CDS for
HIV prevention, as well as to identify contextual barriers and facilitators to CDS.
Qualitative analysis utilized
work domain
analysis and a deductive
coding approach grounded in the Consolidated Framework of Implementation
Research. Quantitative and qualitative data were merged to develop an Implementation
Research Logic Model to conceptualize implementation determinants,
strategies, mechanisms, and outcomes of potential CDS use.
RESULTS:
Participants (n = 26) were primarily
white (92%),
female (88%), and
physicians (73%). Using CDS to improve
HIV testing and PrEP delivery was perceived as highly acceptable (median score 5), IQR [4-5]), appropriate (5, IQR [4-5]), and feasible (4, IQR [3.75-4.75]) using a 5-point Likert scale. Providers identified
confidentiality and
time constraints as two key barriers to
HIV prevention care spanning every
workflow step. With
respect to desired CDS features, providers sought interventions that were integrated into the
primary care workflow, standardized to promote universal testing yet adaptable to the level of a
patient's
HIV risk, and addressed providers'
knowledge gaps and bolstered
self-
efficacy in providing
HIV prevention services.
CONCLUSIONS:
This multiple
methods study indicates that
clinical decision support in the pediatric
primary care setting may be an acceptable, feasible, and appropriate intervention for improving the reach and equitable delivery of
HIV screening and PrEP services. Design considerations for CDS in this setting should include deploying CDS interventions early in the visit
workflow and prioritizing standardized but flexible designs.
