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患者无法接受治疗，并且可能在不知不觉中感染他人，我们提出一种基于移动计算机的视频干预，以提高城市医院急诊（ed）的HIV检测率。ed为许多艾滋病毒高危人群提供了重要的接触点。不幸的是，当ED患者接受常规HIV检测时，大多数患者的病情都有所下降。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一项试验的初步发现之上。该干预以信息-动机和行为技能模型（IMB）为基础，在屏幕上显示一位医生解释HIV检测的重要性（建立知识和动机），并模拟快速HIV检测（增加动机和行为技能）。这种短暂的干预产生了强有力的效果：三分之一的人感染了艾滋病毒