Enhancing Compliance with HIV Testing from the ED

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A previous study of an existing HIV counseling and testing (HIV-CT) referral system in our ED found that only 13% of patients referred for HIV-CT completed testing. Previous work with outpatient tuberculosis screening programs has shown that modest incentives can improve patient compliance. This study will test the hypothesis that incentives (a $10 fast food voucher received when HIV serology results are obtained) will improve compliance of ED patients referred for HIV-CT. A control period of four months, during which no incentive is offered, will be followed by a four month intervention period during which the incentive will be offered. followed by another 4 month control period. The specific aims are: (1) to assess patient characteristics used to select patients for HIV-CT and to test for associations between these characteristics and HIV infection; (2) to assess ED physicians ability to predict HIV seropositivity; (3) to measure the effect of an incentive on compliance with HIV-CT referrals; (4) to measure the effect of the incentive on the number of new HIV-infected patients identified; (5) to measure the effect of the incentive on the number of HIV infected patients who enter HIV care: (6) to apply the Health Belief Model to identify barriers which reduce compliance with HIV-CT; and (7) to estimate the cost of this system, per new HIV-infected patient identified. A telephone questionnaire will be used to measure seven Health Belief Model factors which affect health-related behaviors. The influence of each of these factors on compliance with testing will be determined. The results of this project will guide attempts to improve the effectiveness of ED referral systems for HIV-CT by quantifying the effects of barriers to compliance.