A Quality Improvement Pilot to Increase Hepatitis B Screening and Optimize Patient Selection for the Switch to Two-Drug Antiretroviral Regimens in People With HIV.

Background: Two-drug antiretroviral regimens (2DRs) without tenofovir are increasingly prescribed for HIV; however, these regimens lack full activity against hepatitis B virus (HBV). An electronic health record (EHR)-based quality improvement project was developed to optimize the switch to a 2DR within New York City HIV primary care clinics. Methods: An EHR best practice advisory was linked to 2DR orders (dolutegravir-lamivudine, dolutegravir-rilpivirine, cabotegravir-rilpivirine) reminding clinicians to check HBV serologies prior to the switch and providing guidance for prescribing 2DRs to reduce risk of HBV reactivation in people with HIV. Prescribing patterns were monitored before and after implementation of the alert, including number of individuals screened for HBV-surface antigen (HBsAg), core antibody (HBcAb), and surface antibody-and the number of switches among those with a positive HBsAg (considered at highest risk) or an isolated positive HBcAb (elevated risk). Outcomes were compared for a 1-year period before and after alert implementation on 1 February 2023. Results: After alert implementation, 103 of 145 (71%) individuals had HBV screening prior to a 2DR switch, as compared with 48 of 161 (30%) preimplementation ( Conclusions: HBV reactivation risk may be overlooked by clinicians when people with HIV switch to 2DRs. In this study, an EHR-based intervention increased HBV screening rates and decreased switches in those at highest risk of HBV reactivation (positive HBsAg or isolated positive HBcAb). With the increasing uptake of 2DRs, optimizing patient selection is vital to prevent HBV reactivation.