Enhancing Compliance with HIV Testing from the ED

先前对我们艾德现有的艾滋病咨询和检测（HIV-CT）转诊系统的研究发现，只有13%的患者转诊接受HIV-CT完成检测。以前的工作与门诊结核病筛查计划表明，适度的激励措施可以提高病人的依从性。本研究将检验以下假设：激励措施（获得HIV血清学结果时收到的10美元快餐券）将提高转诊接受HIV-CT的艾德患者的依从性。在四个月的控制期内，不提供奖励，然后是四个月的干预期，在此期间将提供奖励。然后是另外4个月的控制期。具体目标是：（1）评估用于选择患者进行HIV-CT的患者特征，并测试这些特征与HIV感染之间的关联;（2）评估艾德医生预测HIV血清阳性的能力;（3）测量激励措施对HIV-CT转诊依从性的影响;（4）测量激励措施对新识别的HIV感染患者数量的影响;（5）衡量激励措施对进入艾滋病毒护理的艾滋病毒感染者数量的影响：（6）应用健康信念模型来确定降低艾滋病毒-CT依从性的障碍;（7）估计该系统的成本，每个新的艾滋病毒感染者被确定。采用电话问卷调查的方式，测量影响健康相关行为的七个健康信念模型因素。将确定这些因素中的每一个对试验符合性的影响。该项目的结果将指导通过量化遵守障碍的影响来提高艾德转诊系统的有效性。

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.