Taking a Proactive Approach to Prevent HIV Infections

A team of providers at the Kaiser Permanente San Francisco Medical Center have been involved in a clinical care project looking at expanding their HIV prediction model to include new patient variables so that primary care providers will be prompted to have conversations with patients earlier about HIV, and when appropriate, to counsel them on PrEP.

The team developed a study, PrEP Continuum of Care and New HIV infections: Long-Term Follow-Up in a Large Clinical Cohort, and they followed people for several years starting from when they were identified as being potential beneficiaries of this therapy.

Derek Blechinger, MD, MPH, is an internal and preventative physician and HIV specialist at Kaiser Permanante San Francisco Medical Center, and is part of the Kaiser team who developed the prediction model.

Blechinger said the team started off with 88 patient variables and got it down to 44 that they currently use for the prediction model. Rather than wait further along the care process when potential infection opportunities could arise, this is improving upon the current HIV prevention model.

Within Kaiser's electronic health records, Blechinger points out that they have a prompt tab that informs primary care providers to see when patients are due for their influenza vaccine, cancer screenings, etc.

“It allows primary care docs who might not have a lot of expertise in one area to be pinged to say, 'hey this patient needs this,'” Blechinger said. “We are going to integrate this model into our systems so that at all outpatient visits you will see a prompt if someone pings as a very high risk for HIV.”  

Blechinger says they are hoping to use it across the Kaiser health system. Initially, they had planned to do the rollout in 2020, but as he points out, 2020 had other plans, and many of the infectious disease providers there had to deal with the COVID-19 response. Blechinger says they are hoping to roll out the prediction model this year.

Additionally, he is excited to help address the social inequities gap for PrEP therapy. “The model does a good job of identifying folks across all races...so hopefully it will help us to continue to cut down on that gap.”

In the aforementioned study, PrEP adherence was much better after the first year. Blechinger says while it is difficult to fully pinpoint why that is, he offers his observational insights. “I think the biggest reason adherence becomes better after the first year is probably because of habit. They figured out their regimen; they are comfortable with their plan,” Blechinger said.

With the COVID-19 pandemic, it has been challenging to do in-person clinic visits. As such, Kaiser Permanente has adapted to virtual visits and secured emails with patients. With these online visits and email communications, they are talking with patients about PrEP and initiating it remotely.

Contagion spoke to Blechinger recently and he provided further insights about the HIV prediction model, clinical care during COVID-19, and the significance of PrEP.