A few years back, Harvard and Kaiser Permanente Northern California researchers thought up of a great idea – allow doctors to use a software algorithm that would indicate which patients were at risk for becoming HIV-infected.
With it, doctors could prescribe patients with a PrEP medication that would help prevent the spread of the disease.
They manage to create an algorithm that, they claim, can identify which men are at significant risk using the medical information collected about them. This is where it can be tricky. After all, having software determine who’s at greater risk for an HIV infection is a much touchier subject than suggesting a person is at risk for having breast cancer.
How can doctors use this kind of tool? And, if able, how do they broach the subject with the patient in a delicate way?
New York marriage and family counselor Damon L. Jacobs said the tool would be useful for providers. However, it does depend much on the doctor him/herself. If providers are not comfortable with the idea of talking about sex, then the calculator won’t do much good for them.
Plus, patients, especially people in minority groups, do not trust doctors and may not be happy about the idea of this and worried that someone might consider them a player, a slut or anything like that. They may be worried that someone who shouldn’t have access to the record will end up finding out.
Vanderbilt University health policy director Dr. Ellen Wright said doctors shouldn’t just give their results to patients. Rather, they need to ask patients if they’re comfortable with a computer reviewing their records.
Gilead attained approval for the PrEP drug Truvada, which must be taken daily to be effective in preventing the spread of HIV infection. However, only 35 percent of the 1.1 million people who would benefit from using it actually use it. There are about 40,000 new HIV infections each year in the nation.
And, the problem is seen more in the black bisexual and gay men population where one in two will become infected with HIV.
There are several reasons why PrEP use has not caught on as well as it should have. First off, insurers have been hesitant in paying for the pills, which can run $2,100 a month. Second, patients don’t typically have a primary care doctor they feel comfortable with talking about HIV risks.
It’s mostly on the patients to broach the subject about PrEP.
Another issue is that doctors tend to be very busy; they don’t have the time or tools to find out who may or may not be at risk of getting infected.
That’s why software could be useful in their efforts. The challenge is to find the perfect programs that would work best. Researchers came up with several models using close to five million uninfected patient records at Kaiser Permanente and two medical centers in Massachusetts.
Many models were fairly simple – with the software looking at a bit more like sexual orientation and history of STDs. However, some others were far more complex. The scientists used the models to look at the patients’ health records and asked if they could recognize who did become infected with HIV.
In the last model from Kaiser Permanente, there were 44 factors such as living in a region with a high number of HIV infections, using erectile dysfunction medicine, positive urine test for methadone and number of positive urethral gonorrhea tests.
The software identified 2.2 percent of the group that ended up with half of the men being infected with HIV later on. Similar results were seen with the Harvard group. Unfortunately, researchers learned that the patients who became infected with HIV had no idea about PrEP.
Researchers say there is a need to recognize which patients are most at risk, and even if the discussion of sex is difficult, it’s one that must be addressed.
Written by Mark Riegel, MD
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