Optimizing Use of Clinical Decision Support Tools to Enhance and Scale Delivery of Long-Acting Injectables for HIV Prevention and Treatment

About This Grant

PROJECT ABSTRACT Long-acting injectable (LAI) pre-exposure prophylaxis (PrEP) and antiretroviral therapy (ART) represent a promising but underutilized class of HIV medications that can significantly benefit patients who struggle with oral medication adherence. Despite their potential, LAIs face substantial implementation barriers due to their logistical complexity compared to traditional oral medications. While high-volume LAI delivery is currently rare across U.S. HIV clinics, clinical decision support (CDS) systems offer a potential solution for efficiently scaling LAI programs. This project addresses the critical need for infrastructural support in LAI delivery by developing and evaluating a comprehensive Resource Package to accelerate the adoption of LAI-specific CDS in HIV clinics nationwide. We hypothesize that providing clinics with a standardized Resource Package will lead to more efficient workflows, improved care coordination, enhanced patient outcomes, and sustainable LAI program growth. The Resource Package will include: (1) a compendium of LAI-specific CDS tool options with implementation guidance, (2) decision-making worksheets for CDS design, (3) low-fidelity prototypes with adaptable wireframes, (4) build checklists for tool development, and (5) evaluation metrics for assessing CDS tools. Our project has three specific aims. First, we will identify promising CDS tools and processes through synthesis of practices at 10 Clinical Partner Sites currently delivering LAIs at high volume. Second, we will co-create the Resource Package through five multi-disciplinary working groups, each including clinicians, CDS end-users, builders, and implementation scientists. Third, we will assess the Resource Package's impact on clinics' readiness to build LAI CDS tools and their progress in the build process through pre-post surveys and in-depth qualitative analysis. The project will be carried out by an interdisciplinary team including implementation scientists, clinicians, and CDS specialists, working collaboratively with 10 Clinical Partner Sites, two national dissemination partners, and a Community Advisory Board. This research directly responds to NIMH priorities (PAR-22-060 and NOT-MH-23-275) by developing a systematic intervention to promote organizational readiness and capacity for implementing LAIs with fidelity and effectiveness. By establishing a standardized approach to CDS development for LAIs, this project aims to overcome a significant barrier to widespread LAI implementation, ultimately expanding access to these valuable HIV prevention and treatment options for vulnerable populations currently underserved by conventional oral medication approaches.