Dr. Lance Okeke awarded R01 to explore use of electronic health record data to inform strategies for PrEP uptake

Okeke R01

Congratulations to Dr. Nwora Lance Okeke, Assistant Professor of Medicine and Infectious Diseases provider, for being awarded an R01 entitled “Leveraging Local Health System Electronic Health Record Data to Enhance PrEP Access in Southeastern Louisiana: A Community-Informed Approach” along with co-PI Dr. Meredith Clement of Louisiana State University.

Their project seeks to address barriers to HIV pre-exposure prophylaxis (PrEP) uptake in Louisiana, a state where PrEP uptake is among the lowest in the country. Louisiana exemplifies the disparity between PrEP need and uptake in the U.S. South, ranking 4th among US states in HIV incidence in 2018 while ranking 46th in PrEP uptake the following year. To date, few solutions have emerged to address barriers to optimal PrEP utilization in Louisiana and the South overall.

Okeke and Clement’s R01 focuses on the use of machine learning algorithms embedded within the electronic health record (EHR) of large health systems in Southeastern Louisiana to identify persons at increased risk for HIV infection. The team’s previous work demonstrated proof-of-concept of the utility of EHR-based machine learning algorithms for identifying incident HIV cases, outperforming current Centers for Disease Control and Prevention PrEP indication guidelines.

The project seeks to evaluate two novel approaches to expanding EHR-based model implementation beyond their originating health systems and into the communities they serve: 1) an asynchronous strategy involving study team and local community-based personnel notifying community members at risk of HIV infection using a monthly report generated by the EHR risk model, and 2) a real-time strategy using best practice advisories to alert emergency department and urgent care providers of persons flagged as increased risk for HIV by the model during acute care encounters.

The project has assembled a multidisciplinary team of experts in HIV health services research, HIV prevention epidemiology, health informatics, and implementation science. This team will partner with key community-based organizations to leverage the power and reach of health system EHR towards empowering community members with the data they need to make informed decisions about using PrEP.

Says Okeke, “I am really excited to work with this phenomenal team of researchers that leverages a considerable breath of expertise within Duke, and with our partner institutions. Over the next five years, we will be working diligently towards implementing a novel approach to understanding and identifying the risk of HIV acquisition on a population level using the health system as the fundamental population unit. We hope our work will make an impact on attenuating the HIV epidemic in Southeastern Louisiana, and that the lessons we learn from this work can help us better address our local HIV epidemiology in the near future.”