Optimizing Computer-Based Video to Increase HIV Testing in Emergency Departments

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DESCRIPTION (provided by applicant): In this project, we propose to develop and conduct a preliminary evaluation of a computer-based video intervention designed to increase HIV test acceptance in hospital emergency departments (EDs) across the United States. People most in need of HIV testing and prevention education, including drug users and other HIV-infected individuals who are unaware of their infection status, often have little or no access to healthcare outside the ED. Current efforts to offer routine HIV testing in the ED often miss patients who would benefit most. Due to ED staff limitations, most notably time and an already heavy workload, many EDs are not able to offer all patients a test or adequately provide necessary pre-test information. Further, because HIV testing is voluntary, patients at highest risk may decline. Undiagnosed cases of HIV present a significant public health problem, as people who do not know they are infected cannot receive treatment, and may unknowingly spread HIV to others. The intervention developed in this study can be used not only to offer HIV testing to more patients, but to increase the number of patients who agree to be tested. The proposed intervention will employ computer-based video that communicates standardized public health messages in ways patients understand. A video portraying a skilled provider engagingly explaining the importance of HIV testing can be individually delivered on handheld computers to all patients in an ED, while making only minimal personnel demands. Because viewing a video does not require reading, videos are especially suited to lower-literacy populations that seek care in an ED. The proposed research will involve a randomized controlled trial among ED patients who initially decline an HIV test at ED triage to determine what types of video content lead to increases in HIV test uptake and related knowledge. We will also gather data on patient acceptance and the feasibility of the intervention to inform further research to refine the intervention and expand it for use in an array of clinical environments. This study will also provide a new methodology to comparatively evaluate how video content can be optimized for greatest impact. Participants will be randomized into groups that use handheld computers to view different educational video segments and respond to pre- post-intervention data collection instruments. At the end of the intervention, the computers will ask participants if they would like an HIV test. AIM 1 Develop a computer-based video intervention to increase HIV test acceptance and knowledge among ED patients who initially decline an HIV test offered at triage. AIM 2 Evaluate critical dimensions of video content through an early stage randomized controlled trial examining acceptability, feasibility, and effectiveness. This study will begin a valuable line of research testing how video can be optimized for greatest effectiveness while simultaneously educating high-risk patients who might otherwise not be reached. PUBLIC HEALTH RELEVANCE: The Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments (EDs) because people who visit an ED may lack access to other forms of healthcare, and if they are not tested for HIV, may be infected for years before receiving a diagnosis. Unfortunately, current testing efforts often fail to reach those most at risk. This study will develop and evaluate the acceptability, feasibility and preliminary effectiveness of an automated, computer-based video intervention, which offers considerable promise for increasing HIV test acceptance in EDs across the United States, thus having a marked public health impact.