The Implementation of a State-wide Rapid Initiation of Antiretroviral Therapy as a Best Practice in Primary Care Practices Using an Academic Detailing Approach: Lessons Learned from NewYork State, United States

Abstract

Background: NewYork State Department of Health AIDS Institute policy recommends that primary care clinicians should initiate same-day-antiretroviral treatment (ART) of a new HIV diagnosis or at the next clinical visit as the standard of care. However, non-HIV-specialized primary care clinicians might not be sufficiently trained to initiate a specialized ART with a newly HIV diagnosed patient. We assessed clinicians’ knowledge and attitudes toward the rapid initiation of ART and provided academic sessions as a training method to guide clinicians through the implementation of a new standard of care. Methods: A Research Electronic Data Capture (REDCap), Health Insurance Portability and Accountability Act (HIPAA)-compliant, online survey was sent to primary care clinicians to assess their knowledge and attitudes towards Rapid Initiation of ART (RIA). We provided personalized academic detailing sessions, addressing questions and concerns gathered from both the initial survey and the individual pre-assessment questionnaire completed prior to the sessions. Results: The survey was initially distributed in February 2019, followed by 4weekly reminders. Approximately 585 providers completed the survey. Subsequently, 552 health care providers from 25 out of 62 counties in NY State were detailed between March 2019 and March 2021. Lessons learned from the sessions included the identification of pragmatic strategies that could be used in the design of effective detailing sessions, followed by enhanced clinical knowledge, which improved patient care. Conclusion and Global Health Implications: Inconsistencies in the current testing practices result in missed HIV diagnoses and an increased risk of HIV transmission.Academic detailing-training techniques can be used to respond to clinician-identified key issues/attitudes that may result in a new intervention, suggesting a promising approach in addressing the implementation barriers of of rapid-treatment initiation as the standard of care. The academic detailing approach can be easily adapted and can be beneficial in global public health, HIV/ AIDS control, and other conditions that require a medical practice change. Copyright © 2022 Barbosu et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

A realist synthesis of educational outreach visiting and integrated academic detailing to influence prescribing in ambulatory care: why relationships and dialogue matter

“…Programme design features significantly influence their relevance to the practice of clinicians, their engagement and whether desired changes in prescribing are achieved. Successful programme design integrates current evidence practice gaps,38–41 builds on understanding of the target audience’s practice and barriers to practice change12 41 42 and then mindfully takes this knowledge, understanding, attitudes, behaviours and needs of its audience into account, which assists to anticipate potential barriers to and enablers for suggested change 43–45. In combination, these increase the overall appeal and relevance of the programme and clinician engagement,11 12 46 47 and are supported by the involvement of clinicians or topic experts in programme design, the utilisation of (local) prescribing data and needs assessments via surveys or interviews 2 48–51…”

“…Translation of evidence into practical advice as part of programme design is valued by clinicians. Recommendations supplementing evidence summaries or made verbally by the visitor have to be applicable to and easy to action in daily practice and action has to lie within the control of clinicians 12 38 41 43 65. Information about practice-gaps and recommendations that support patient care may assist in overcoming barriers to practice change by facilitating reflection and cognitive dissonance 12 39 66.…”

“…A commitment or intention to change practice is a precursor to actual change in prescribing,16 41 59 in line with Theory of Planned Behaviour 32. Both were mainly self-reported via surveys of clinicians’ or visitors’ perceptions55 61 62 64 76 and often described in non-specific terms (general intention to change practice), not explicitly related to actual programme messages and intentions, or specified as a commitment to review patients, change prescribing, implement agreed actions 16 38 40 47 51 68.…”

Perceptions toward antiretroviral therapy and delayed ART initiation among people living with HIV in Changsha, China: mediating effects of treatment willingness

“…However, up to 30% of PLWH might delay their treatment both in developed and developing countries ( 12 , 13 , 14 ). The attitude and knowledge of clinicians ( 15 ), the interface of services between facilities, and limited resources have been reported as external factors affecting ART initiation ( 16 , 17 ). Patients’ personal factors may also contribute to delayed initiation, such as demographic factors including low income, low education, and lack of household decision-making power ( 18 ), HIV-related characteristics ( 14 ), mental health ( 19 , 20 ), and perceptions toward ART ( 21 ).…”