This World AIDS Day – Reflecting on Health IT as a Tool for Advancing Health Equity and Ending the HIV Epidemic
Carmela Couderc; Whitney Weber and Michael Wittie | December 1, 2022
December 1st is World AIDS Day, when we collectively remember those who died due to AIDS-related illnesses and renew our commitment to work together to end the HIV epidemic and support people with HIV. This year’s theme, “Putting Ourselves to the Test: Achieving Equity to End HIV,” emphasizes accountability and action. Collaborative, community-based, cross sector, and whole-of-government approaches that address clinical and social determinants of health (SDOH) are needed to support communities disproportionally affected by HIV and achieve national HIV/AIDS goals. Interoperable health IT, with health equity as a fundamental design feature, is an important tool to enable these efforts.
Health IT was incorporated into the latest National HIV/AIDS Strategy Federal Implementation Plan for the United States 2022-2025. Strategy 4.3.2 in the plan is focused on using health IT to enhance HIV prevention efforts, support early intervention, and improve care outcomes. The actions under this strategy are focused on advancing data standards to facilitate interoperability, including clinical decision support for HIV testing and treatment, HIV case management and care coordination, and social determinants of health information exchange.
Standards Facilitate HIV Data Interoperability
Health IT standards such as the United States Core Data for Interoperability (USCDI) support interoperable health information exchange across care settings, including within and between certified electronic health records (EHRs) and other information systems in the community.
USCDI v3 includes data elements for health equity factors that facilitate appropriate, quality care for people with HIV including race, ethnicity, preferred language, disability status, sex, gender identity, sexual orientation, and social determinants of health. USCDI data elements such as lab results and healthcare goals used in conjunction with health equity data such as race and ethnicity also allow providers and public health agencies to measure and address disparities and the disproportionate impact of HIV on racial and ethnic minorities.
ONC has supported recent initiatives for health IT software developers to pilot standards such as the SDOH Clinical Care FHIR Implementation Guide that aligns with USCDI. Advancement of interoperability standards can support important population health strategies for HIV prevention and treatment.
Interoperability to Advance Clinical Decision Support and HIV Case Management
Health IT can advance HIV service delivery and population health across the HIV care continuum. For example, the increased range and higher quality of patient data that certified health IT enables can facilitate more informed testing strategies. Providers can use their health IT systems to identify patients in need of HIV testing and to inform prevention strategies, such as prescribing pre-exposure prophylaxis, also known as PrEP.
Similarly, the U.S. Department of Health and Human Services (HHS) Community Preventive Services Task Force recommended that providers use clinical decision support (CDS) to help them increase HIV screening. CDS has further potential to reduce inequities and inform testing and referrals with the advancement of standardized data elements (including those in USCDI v3), and availability of data in interoperable health IT systems.
Once a person is in HIV care, team members in different settings can share and receive data securely to support case management, care coordination, public health, and patient engagement. Clinicians and other health professionals are using data sources to identify patients not in care and connect them to services. As technology and interoperability evolves, providers will have new and enhanced opportunities to facilitate status-neutral testing strategies, connect individuals to HIV prevention and treatment services, and address access barriers and social determinants of health.
SDOH Information Exchange for Holistic HIV Approaches
Social circumstances and systemic inequities can interact to worsen the impact of infectious diseases and epidemics, including HIV, mpox, and COVID-19. Addressing SDOH and barriers to care are important aspects of connecting people to HIV prevention and treatment services through a holistic, status neutral approach, and supporting retention in HIV care. By leveraging modern technologies, HIV prevention and treatment providers can coordinate with other services in the community and perform electronic referrals to address the needs of individuals with complex and interrelated health and social needs.
Communities across the United States are working to advance health equity and address SDOH using information technology through the capture, exchange, and use of SDOH data. ONC’s Social Determinants of Health Information Exchange Learning Forum includes lessons learned, promising practices, and challenges related to exchanging SDOH data. Enhancing data infrastructure, improving connections between health and social service providers, and engaging in whole-of-government collaborations to implement comprehensive solutions are part of HHS’s three-pronged strategy to address SDOH.