2503. Differences Between Experts and Community Clinicians in Selecting HIV Switch Regimens for Patients With Viral Suppression

BACKGROUND: Patients and clinicians may consider switching suppressive HIV regimens for a variety of reasons, including simplification, improved safety and tolerability, drug interactions, or cost. Because switching treatment is a common clinical dilemma in current HIV care, we developed an online treatment decision support tool to assist providers on selecting a new regimen in a variety of patient scenarios. METHODS: In March 2018, 5 HIV experts provided treatment recommendations for more than 1300 unique HIV switch case scenarios based on a simplified set of variables: CVD, HLA-B*5701, HBV, drug resistance, current ART, and component requiring a switch. We then developed a decision support tool that enabled clinicians to specify a patient scenario using these variables and to select their currently intended approach. The experts’ recommendations for that specific case were then shown, and clinicians were asked if the recommendations changed their planned treatment. RESULTS: In the 5 months following release of the tool, healthcare providers (HCPs) entered 932 patient case scenarios. A comparison of HCPs treatment plans vs expert selections in select patient case scenarios is shown in Tables 1 and 2. The data demonstrated several key areas of discordance, including the more frequent selection of the following options by HCPs vs. experts across a wide range of case scenarios: (a) Boosted regimens: 18% to 31% vs. 0% to 4% of cases; (b) TDF-containing regimens: 7% to 25% vs. 0% of cases; and (c) PI-based regimens: 9% to 23% vs. 0% to 4% of cases. In a subset of 88 patient case scenarios where HCPs’ intended treatment differed from experts and HCPs also self-identified the impact of the tool, 48% indicated that their treatment plan would change/agreed with experts after using the tool. CONCLUSION: This online HIV switch decision support tool shows substantial differences between experts’ and HCPs’ treatment choices for switching therapy in multiple case scenarios. Moreover, consensus expert selections in this online tool resulted in a change to the intended treatment plan for approximately one half of users, suggesting use of the tool can help optimize selection of a new ART regimen for patients switching in the setting of virologic suppression. [Image: see text] [Image: see text] DISCLOSURES: All authors: No reported disclosures.