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Technology-enabled expert clinical decision making to fast-track HIV-1 viral load result uptake among the network of providers at antiretroviral treatment centers, Maharashtra, India

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BACKGROUND: In Maharashtra state, antiretroviral therapy (ART) services are delivered through a tiered pyramidal network of an Adult and Paediatric Centre of Excellence (CoE) at the Apex, 14 ART plus centres, and 91 ART centres catering to 383,790 people living with HIV (PLHIV). The CoEs and ART plus centres have the additional role of mentoring the clinical network of providers and supporting clinical decision-making regarding ART switching through designated State AIDS Clinical Expert Panels (SACEP). Previously, PLHIV would need to be physically present at the SACEP, which led to a cascade of challenges, including decreased access to SACEP due to expenses, delays, and the rescheduling of appointments. Furthermore, the COVID-19 pandemic aggravated challenges for in-person consultations and delayed critical expert input.
DESCRIPTION: SinceApril 2020, the Tele-SACEP intervention was initiated to provide timely e-consultations for utilization of viral load results and other clinical decisions. We reviewed data to estimate PLHIV with pending SACEP consults and developed a Standard Operative Procedure per national guidelines, incorporating patient confidentiality and a meeting calendar for patient appointments. We used the Zoom® platform to facilitate case discussions between the ART center staff and SACEP Panels with patients who could attend their closest ART center, preserving patient confidentiality. The SACEP decision was shared with referring ART center providers on the same day for appropriate action for patient care.
LESSONS LEARNED: In the 390 Tele-SACEP meetings held, 6,641 cases were reviewed from April 2020 to December 2021. Of these, 4,678 (70%) were recommended for ART switch or substitution with a short turnaround time (TAT). When comparing the median and mean TAT between January 2016 and March 2020 (31 and 44 days) to the median and mean TAT between April 2020 to December 2021 (07 and 17 days), there was a significant difference from referral to the actual SACEP meeting.
CONCLUSIONS: Technology-enabled SACEPs resulted in the provision of timely clinical decisions and increased the number of referrals for required expert consultation. In addition to providing critical connections during the COVID-19 pandemic, the process intuitively strengthened the clinical acumen of the in-network clinicians through case discussions and aided in easy access to the SACEP.