A Clinical Decision Support System is Associated with Reduced Loss to Follow-Up Among Patients Receiving HIV Treatment in Kenya: A Cluster Randomised Trial

Abstract Background Loss to follow-up (LFTU) among HIV patients continues to be a major obstacle to achieving treatment goals with the risk of failure to achieve viral suppression and thereby increased HIV transmission. Although use of clinical decision support systems (CDSSs) has been shown to improve adherence to HIV clinical guidance, this is the first study ever conducted to show its effect on LTFU in low-resource settings. Methods We analyzed data from a cluster-randomized trial conducted at 20 HIV clinics in western Kenya to assess the effects of a CDSS implemented as alerts on an electronic health records (EHR) system on: (1) the proportion of patients that were LTFU, (2) LTFU patients traced and successfully referred back to treatment, and (3) the time from enrollment on treatment to LTFU. Results Among eligible 5,901 patients receiving ART, 40.6% (n=2,396) were LTFU at any time during the study period. Lack of a CDSS was associated with higher LTFU among the ART patients (Adjusted Odds Ratio - aOR=1.45, 95% CI: 1.35-1.55). The proportions of patients linked back to treatment were 29.1% (95% CI: 27.6– 0.6) and 34.1 % (95% CI: 32.1–36.2) in EHR only and EHR with CDSS sites respectively. There was no statistically significant association between the use of a CDSS and time to LTFU.Conclusion A CDSS can potentially improve quality of care through reduction of LTFU among HIV patients in a resource-limited country. CDSS is only part of the solution to LTFU and would be most effective if implemented together with other interventions.