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.
it, doctors could prescribe patients with a PrEP medication that
would help prevent the spread of the disease.
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
can doctors use this kind of tool? And, if able, how do they broach
the subject with the patient in a delicate way?
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.
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.
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
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.
the problem is seen more in the black bisexual and gay men population
where one in two will become infected with HIV.
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.
mostly on the patients to broach the subject about PrEP.
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
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
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.
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.
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.