prep candidates to identify cisgender female validation of an ... · jessica ridgway, md, ms;...
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Validation of an Electronic Algorithm to Identify Cisgender Female
PrEP CandidatesJessica Ridgway, MD, MS; Eleanor Friedman, PhD;
Alvie Bender, MSW; Jessica Schmitt, LCSW;Michael Cronin, BA; Rachel Goins, MSW;
LeChae Mottley, MSW; Lisa Hirschhorn, MD
PrEP use among women in the United States
New HIV diagnoses
MF
Active PrEP users
MF
Siegler, Annals of Epidemiology 2018
Only a small fraction of women with an indication for PrEP are actively taking it
Indication for PrEP Taking PrEP0
20000
40000
60000
80000
100000
120000
140000
160000
180000
200000
Siegler, Annals of Epidemiology 2018Smith, Annals of Epidemiology 2018
PrEP Continuum of Care
Nunn, AIDS 2017
Identifying cisgender women who may benefit from PrEP
Ideally healthcare providers would talk with all cisgender women about HIV risk and prevention including PrEP.
In high-throughput or low resource settings, can we use an electronic medical record (EMR)-based alert to identify potential PrEP candidates?
Aim of studyEvaluate the performance of an EMR-based algorithm for identifying cisgender women who are potential PrEP candidates in the Emergency Department
EMR alert: risk score calculation
EMR data Risk score value
Male 7
Chief complaint related to STI-associated symptoms
6
Age <=20 13Age 21-24 8Positive STI test in the prior 6 months
16
MSM 16
Ridgway, AIDS Patient Care & STDs 2018
Score ≥ 16 results in automated electronic alert to HIV prevention counselor
Methods
• Retrospective validation
• Prospective validation
Retrospective EMR alert validation
• Retrospective review of cisgender women newly diagnosed with HIV in UCM ED, 2011-2018
• Determined if EMR algorithm identified them as PrEP candidates at index ED visit
Results: retrospective EMR alert validation
• Among 22 women diagnosed with HIV in ED, 2 (9%) women identified by EMR algorithm during visit when diagnosed
• 8 women had prior UCM ED visits– 1 of these women identified by EMR algorithm during prior
visit
• Most cisgender women did not present to ED for chief complaint related to STI symptoms
Prospective EMR alert validation
• Surveyed cisgender women seeking care in the UCM ED between May 7, 2018 and August 31, 2018 regarding behavioral risk factors associated with HIV acquisition
• Determined if they had a PrEP indication based on CDC guidelines
• Calculated performance characteristics of EMR alert for identifying cisgender female PrEP candidates
Results: prospective EMR alert validation
• 245 cisgender women surveyed
• 90% African American, 5% Latina
• Median age 28 years
24% (59/245) with PrEP indication
Results: prospective EMR alert validation
PrEP Indication*
No PrEP Indication*
Total
EMR Alert 6 8 14No EMR Alert 53 178 231Total 59 186 245
*Based on self-reported behaviors in survey responses
Results: prospective EMR alert validation
PrEP Indication*
No PrEP Indication*
Total
EMR Alert 6 8 14No EMR Alert 53 178 231Total 59 186 245
*Based on self-reported behaviors in survey responses
Performance characteristics of EMR alert among cisgender women
Sensitivity 10%
Specificity 96%
Positive predictive value 43%
Negative predictive value 77%
Why so many “false negatives?”
• Most common PrEP indications among those not EMR alerted–Condomless sex with multiple partners of
unknown HIV risk–Recent STI based on self-report
(not documented in UCM EMR)
Conclusions• In healthcare settings unable to provide PrEP education
to all patients, clinical informatics interventions may be helpful.
• Current EMR alert has low sensitivity but high specificity for identifying cisgender women with a PrEP indication.
• Future plans to examine other EMR data and additional data sources that may improve the sensitivity of the EMR alert among cisgender women.
Acknowledgments• Coauthors• Study participants• University of Chicago EDFunding provided by an administrative supplement to the Third Coast Center for AIDS Research (CFAR) (P30 AI117943)
Contact: [email protected]