Three Drugs, Two Pills, One Algorithm: A Cross-Sectional Pilot Study of Consolidated Guidelines for HIV PrEP, PEP, and Treatment Initiation for Resource-Limited and Non-specialty Settings in the United States.

BackgroundAccessing HIV prevention and treatment remains difficult throughout the United States (US). With the shortage of infectious disease physicians, increasing the number of clinicians offering HIV Pre-Exposure Prophylaxis (PrEP), HIV Post-Exposure Prophylaxis (PEP), and Test & Treat (T&T) is imperative. This exploratory project created a consolidated algorithm for HIV treatment and prevention that simplifies care for US providers with limited resources or experiences.MethodsThe algorithm was designed for PrEP, PEP, and treatment initiation using published guidelines from multiple clinical bodies. Three medications were included in the algorithm: tenofovir disoproxil fumarate, emtricitabine, and dolutegravir. US medical students completed an eight-question pretest unassisted then repeated questions with the algorithm to test the algorithm's functionality. Questions included clinical scenarios on HIV testing, PrEP, PEP, and T&T. Pearson's chi-squared compared pre vs post-test scores; total scores (number of items correct) were analyzed using Paired Wilcoxon signed rank test.Results97 students from 13 medical schools completed pre and post-test questions. Correctness increased from 3 of 8 (pretest) to 7 of 8 (post-test) (p< 0.001). All questions saw statistically significant improvement in correctness when assisted by the algorithm including correctly prescribing PEP, selecting appropriate labs for PrEP initiation, and screening patients with prior cabotegravir-based PrEP using HIV RNA quantitative (p<0.001 for all).ConclusionsThis algorithm improved medical students' abilities to accurately answer HIV clinical care questions about HIV prevention and treatment. Further studies are needed to understand the algorithm's effect in clinical settings and how to implement it in practice.