Clinical Decision-support Reminders to Improve IPT Initiation Among HIV Positive Adults in Western Kenya

Study Overview
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Brief Summary
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The overall research objective is to evaluate the impact of implementing a reminder system for medical providers to improve TB case-finding and isoniazid preventative therapy (IPT) for adults living with HIV in western Kenya

Detailed Description
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The purpose of this study is to evaluate the impact of implementing a clinical decision support reminder system for medical providers (i.e., nurses, clinical officers, medical officers, consultants) to improve tuberculosis case-ﬁnding and the use of isoniazid preventative therapy for adults living with HIV in western Kenya.

Official Title
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Does Providing Medical Personnel in the AMPATH Network With Patient-specific Reminders Regarding TB That Are Generated From a Patient's EMR Improve the Prevalence of IPT Initiation and Decrease the Time From Screening to Treatment?

Conditions
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Tuberculosis

Intervention / Treatment
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* Behavioral: TB reminders


Participation Criteria
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Eligibility Criteria
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Clusters: Inclusion Criteria active uses HIV initial and return encounter paper forms enters data into the AMPATH medical records system (AMRS) or sends forms to central location for data entry prints or receives printed paper summary sheets with reminders interprets chest x-rays interprets sputum smear results prescribes IPT and dispenses INH completed an average of 10 initial adult HIV positive encounters per month in 2012 HIV Care Clinic Exclusion Criteria - Patients: Inclusion Criteria HIV positive complete an adult initial encounter at an HIV Care Clinic during the enrollment period attend at least one additional appointment within 90 days after the initial encounter Exclusion Criteria - history of TB or IPT

Ages Eligible for Study
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Minimum Age: 16 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Quadruple


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: TB reminders<br>Receive existing reminders plus new patient-specific reminders about TB screening, prevention, and treatment | Behavioral: TB reminders<br>* The intervention to be studied involves providing clinic-based medical care providers (e.g., nurses, clinical officers, medical officers, consultants) with patient-speciﬁc clinical reminders regarding TB that are generated from a patient's electronic medical record and based on accepted clinical algorithms for TB screening and treatment.<br>|
| No Intervention: No TB reminders<br>Only receive existing reminders; no TB reminders | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Prescription of Isoniazid | Provider prescribes INH within 3 months of patient's initial encounter. | within 3 months of initial encounter | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Time to isoniazid prophylactic therapy (IPT) initiation | The time in weeks from a patient's initial encounter to the week the patient picks up the initial batch of INH from the pharmacy. | within 3 months of initial encounter | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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tuberculosis, isoniazid preventative therapy, clinical decision support, HIV, Kenya, eHealth