Evaluation of a persuasive health communication intervention designed to increase HIV/HCV screening among emergency departments patients who currently, formerly or never injected drugs

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Project summary A major impediment to adult emergency department (ED)-based HIV/HCV screening success is that often ED patients at risk for, or later diagnosed with, HIV and HCV decline testing. However, for patients who decline HIV/HCV screening, there is no evidence-based intervention to persuade them to be tested. In response to the deficit of an intervention to increase ED HIV/HCV screening acceptance, we recently completed an R34 project during which we developed a persuasive health communication intervention (PHCI) with stakeholder assistance (ED patients, HIV/HCV counselors, and ED medical staff). In two pilot studies, we examined the efficacy of the PHCI among adult ED patients who initially declined HIV/HCV screening. In one pilot study, adult ED patients assigned to watch a control condition video were more likely to agree to be tested than those who received the PHCI in-person from an HIV/HCV counselor (n=56, 27% vs. 10%; ∆17%, ∆95% CI: 6-32%). However, in a separate pilot study, adult ED patients randomly assigned to watch a video of a physician delivering the PCHI to an ED patient were more likely to agree to be tested than those who watched the control condition video (n=60, 29% vs. 11%; ∆18%, ∆95% CI: 7-35%). These results suggest that the PHCI video might increase HIV/HCV screening acceptance more than a PHCI delivered in-person by an HIV/HCV counselor. If these results are confirmed in a larger study, the PHCI video could enable wider usage of the PHCI and facilitate greater acceptance of ED HIV/HCV screening. Unfortunately, in our R34 project we did not develop nor evaluate the PHCI among current and former people who inject drugs (PWIDs). As such, the current PHCI might be inadequate in persuading current/former PWIDs to be tested, and thus needs modification with the help of current/former PWIDs to be effective for these very high HIV/HCV-risk patients. In this R01 project, we first will modify the PHCI with input from current/former PWIDs. Next, we will conduct a randomized, controlled trial (RCT) to compare the PHCI’s efficacy when delivered by a video vs. an HIV/HCV counselor. Adult ED patients who declined HIV/HCV screening will be stratified by IDU history: (1) current/former PWIDs or (2) never/non-PWIDs. Within each of these strata, we will randomly assign participants to a PHCI delivered by (1) video (2) HIV/HCV counselor. Current/former PWIDs will receive the PHCI modified for PWIDs, whereas never/non-PWIDs will receive the non-modified, original PHCI version. For Aim 1, we will determine which delivery form of the PHCI (video or HIV/HCV counselor) results in more ED patients accepting HIV/HCV screening, independent of their history of IDU. For Aim 2, we will determine which delivery form of the PHCI results in more ED patients accepting HIV/HCV screening within each IDU history cohort (current/former PWIDs, never/non-PWIDs), and if testing acceptance is similar across IDU history cohorts. For Aim 3, we will further compare the two PHCI delivery forms through a health economics assessment, both independent of IDU history and within each IDU history cohort.