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

基本信息

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
项目类别：
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

项目摘要

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）：由于未经诊断的艾滋病毒的人不会接受治疗，并且可能在不知不觉中感染其他人，因此我们提出了一种基于移动计算机的视频干预措施，以提高大量城市医院急诊室（EDS）的HIV测试率。 EDS为许多艾滋病毒风险最大的人提供了重要的联系点。不幸的是，当向ED患者提供常规的HIV测试时，大多数下降。我们提出的干预措施是基于我们研究团队与拒绝艾滋病毒测试的患者进行的初步发现的基础。该干预措施以信息动机和行为技能模型（IMB）为基础，显示了一名屏幕上的医师，该医师解释了HIV测试（建立知识和动机）的重要性（以建立知识和动机）并建模快速的HIV检验（以提高动力和行为技能）。这种简短的干预效果有效：第三个接受的艾滋病毒测试干预后。尽管这项初步研究令人鼓舞，但它揭示了许多其他重要的研究问题。首先，目前尚不清楚哪些干预部分最有力地促进了患者的测试决定：视频内容或计算机而不是人提供的HIV测试。其次，与文献一致，参与者表示，屏幕上披露艾滋病毒阳性状态的社区成员将增加测试患者的比例。第三，结果表明，在屏幕上社区成员或专家（例如医师）对行为更强烈影响的程度上存在各种变化。因此，在IMB模型的指导下，本研究的目的是确定如何完善基于移动计算机的干预措施，以最大程度地提高最初拒绝在ED中进行测试的患者的HIV测试率。本研究将使用飞行员四臂随机控制设计。所有参与者将使用移动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）。一只手臂会看到医生的视频，解释了艾滋病毒测试和建模快速测试的重要性（类似于原始视频）。第二臂将观看一个社区成员的视频，该视频解释了测试重要性，模型测试，并披露了他的艾滋病毒阳性。三分之一将可以选择观看两个视频中的哪个。第四组（对照）将看不到任何视频。在计算机干预的末尾（仅预测试/视频或预测试），屏幕文本会询问患者是否同意艾滋病毒检查。那些同意的人将由ED员工进行测试。该试验将在纽约市圣卢克医院中心的Ed招募18-64岁的患者（n = 300）。该设施每年为大约100,000名患者提供服务，大约45％的黑人或非裔美国人，40％的西班牙裔或拉丁裔。该研究的目的是设计，开发，测试和评估一组精致的基于移动计算机的干预组件，包括简短的视频。该研究的终点将是干预后的HIV测试率。另一个目的是更好地了解患者对干预措施的经历，并使用定性方法提出员工对实施的看法。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。