Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

通过移动技术增加城市急诊科的艾滋病毒检测

• 批准号: 8860165
• 负责人: Ian David Aronson
• 金额: $ 24.03万
• 依托单位: NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8860165
• 关键词: AIDS prevention; Accident and Emergency department; Address; Adult; African American; Alcohol abuse; Alcohol or Other Drugs use; Area; Behavior; Behavioral; Blood; Caring; Centers for Disease Control and Prevention (U.S.); Characteristics; Clinical; Communities; Computers; Control Groups; Data; Emergency Department patient; Face; Funding; Goals; HIV; HIV Infections; HIV Seropositivity; HIV diagnosis; HIV risk; Health; Health Personnel; Health Priorities; Health Services Accessibility; Hispanics; Hospitals; Human immunodeficiency virus test; Incentives; Individual; Intervention; Interview; Knowledge; Latino; Learning; Life; Literature; Measures; Modeling; Motivation; National Institute of Drug Abuse; New York; New York City; Nurse Administrator; Nurses; Oral; Participant; Patients; Persons; Phase; Physicians; Population; Prevalence; Process; Qualitative Methods; Randomized; Recruitment Activity; Reporting; Research; Research Personnel; Risk; Solutions; Staging; Technology; Testing; Text; Treatment Efficacy; Triage; Underserved Population; Urban Hospitals; Variant; Vulnerable Populations; Work; aged; arm; base; behavior change; brief intervention; computerized; cost; demographics; design; disorder prevention; experience; high risk; improved; member; motivated behavior; post intervention; randomized trial; screening; skills; therapy design

DESCRIPTION (provided by applicant): Because people with undiagnosed HIV will not receive treatment and may unknowingly infect others, we propose a mobile computer-based video intervention to increase HIV test rates in high volume urban hospital emergency departments (EDs). EDs offer important points of contact for many of those at greatest risk for HIV. Unfortunately, when ED patients are offered routine HIV testing, most decline. Our proposed intervention builds upon initial findings from a trial our research team conducted with patients who declined HIV testing. The intervention, grounded in the Information-Motivation and Behavioral Skills model (IMB), showed an onscreen physician explaining the importance of HIV testing (to build knowledge and motivation) and modeling a rapid HIV test (to increase motivation and behavioral skill). This brief intervention had a potent effect: a third accepted HIV testing post-intervention. While this preliminary study is highly encouraging, it revealed a number of other critical research questions. First, it remains unclear what intervention component most strongly contributed to patients' decisions to test: the video content or the offer of an HIV test by a computer rather than a person. Second, consistent with the literature, participants indicated a community member disclosing positive HIV status onscreen would increase the proportion of patients who test. Third, results suggest there is individual variation n the extent to which behavior is more strongly influenced by onscreen community members or experts (e.g. physicians). Therefore, the goal of the present study, guided by the IMB model, is to determine how we can refine mobile computer-based interventions to maximize HIV testing rates among patients who initially decline to test in the ED. The present study will use a pilot four-arm randomized controlled design. All participants will use mobile computers to complete a pre-test assessment (socio-demographics, HIV test knowledge, substance use screening). One arm will see video of a physician explaining the importance of HIV testing and modeling rapid testing (similar to the original video). The second arm will view video of a community member who explains testing importance, models testing, and discloses he is HIV positive. A third will have a choice of which of the two videos to watch. A fourth group (control) will not see any video. At the end of the computerized intervention (pre-test/video or pre-test only), onscreen text will ask patients if they would agree to an HIV test. Those who agree will be tested by ED staff. The trial will recruit patients (N=300) aged 18-64 in the ED of St. Luke's Hospital Center in New York City. The facility serves roughly 100,000 patients each year, approximately 45% Black or African American and 40% Hispanic or Latino. The aims of the study are to design, develop, test, and evaluate a refined set of mobile computer-based intervention components, including brief videos. The study's endpoint will be post-intervention HIV test rates. Another aim is to better understand patient experience with the intervention, and elicit staff perspectives on implementation using qualitative methods. Our study will inform scalable interventions for underserved populations nationwide.

描述（由申请人提供）：由于未确诊的HIV感染者不会接受治疗，可能会在不知不觉中感染他人，因此我们提出了一种基于移动的计算机的视频干预，以提高高容量城市医院急诊室（ED）的HIV检测率。ED为许多艾滋病毒风险最高的人提供了重要的接触点。不幸的是，当艾德患者接受常规艾滋病毒检测时，大多数人都会下降。我们提出的干预措施建立在我们的研究小组对拒绝艾滋病毒检测的患者进行的试验的初步结果基础上。该干预措施以信息动机和行为技能模型（IMB）为基础，由一名内科医生解释艾滋病毒检测的重要性（以建立知识和动机），并建立快速艾滋病毒检测模型（以增加动机和行为技能）。这种短暂的干预产生了强大的效果：三分之一的人接受了艾滋病毒 干预后测试。虽然这项初步研究非常令人鼓舞，但它揭示了许多其他关键研究问题。首先，目前尚不清楚哪些干预因素对患者决定进行检测的影响最大：是视频内容还是由计算机而不是个人提供艾滋病毒检测。第二，与文献一致，参与者表示，社区成员披露艾滋病毒阳性状态会增加检测患者的比例。第三，研究结果表明，行为在多大程度上受到社区成员或专家（如医生）的强烈影响存在个体差异。因此，本研究的目标，IMB模型的指导下，是确定我们如何能够完善移动的基于计算机的干预措施，以最大限度地提高艾滋病毒检测率的患者谁最初拒绝测试在ED。本研究将使用一个试点四臂随机对照设计。所有参与者将使用移动的计算机完成测试前评估（社会人口统计学、HIV测试知识、物质使用筛查）。一只手臂将看到医生解释HIV检测和建模快速检测的重要性的视频（类似于原始视频）。第二组将观看社区成员的视频，该成员解释测试的重要性，模型测试，并透露他是HIV阳性。第三个人可以选择观看两个视频中的哪一个。第四组（对照组）不会看到任何视频。在计算机化干预结束时（预测试/视频或仅预测试）， 会询问患者是否同意进行艾滋病病毒检测。同意者将由艾德工作人员进行测试。该试验将在纽约市圣卢克医院中心的艾德招募18-64岁的患者（N=300）。该设施每年为大约10万名患者提供服务，其中大约45%是黑人或非裔美国人，40%是西班牙裔或拉丁美洲人。该研究的目的是设计、开发、测试和评估一套完善的基于移动的计算机的干预组件，包括简短的视频。该研究的终点将是干预后的艾滋病毒检测率。另一个目的是更好地了解病人的经验与干预，并使用定性方法的实施工作人员的观点。我们的研究将为全国服务不足的人群提供可扩展的干预措施。