Enhancing Compliance with HIV Testing from the ED

先前对我们急诊室现有的HIV咨询和检测（HIV- ct）转诊系统的研究发现，只有13%的患者完成了HIV- ct检测。以前在门诊肺结核筛查项目上的工作表明，适度的激励措施可以提高患者的依从性。这项研究将验证这样一种假设，即奖励措施（获得HIV血清学结果时可获得10美元的快餐券）将提高转到HIV- ct的ED患者的依从性。在4个月的控制期（不提供奖励）之后，将有4个月的干预期（提供奖励）。然后是另一个4个月的对照期。具体目的是：(1)评估用于选择HIV- ct患者的患者特征，并测试这些特征与HIV感染之间的关联；(2)评估ED医师预测HIV血清阳性的能力；(3)衡量激励措施对HIV-CT转诊依从性的影响；(4)衡量激励措施对新发现艾滋病毒感染者人数的影响；(5)衡量激励对HIV感染者进入HIV护理人数的影响；(6)应用健康信念模型识别降低HIV- ct依从性的障碍；(7)估计该系统的成本，每个新发现的艾滋病毒感染者。采用电话问卷的方式测量影响健康相关行为的七个健康信念模型因素。将确定这些因素对符合检测的影响。这个项目的结果将通过量化对依从性障碍的影响来指导提高ED转诊系统对HIV-CT的有效性的尝试。

A previous study of an existing HIV counseling and testing (HIV-CT) referral system in our ED found that only 13% of patients referred for HIV-CT completed testing. Previous work with outpatient tuberculosis screening programs has shown that modest incentives can improve patient compliance. This study will test the hypothesis that incentives (a $10 fast food voucher received when HIV serology results are obtained) will improve compliance of ED patients referred for HIV-CT. A control period of four months, during which no incentive is offered, will be followed by a four month intervention period during which the incentive will be offered. followed by another 4 month control period. The specific aims are: (1) to assess patient characteristics used to select patients for HIV-CT and to test for associations between these characteristics and HIV infection; (2) to assess ED physicians ability to predict HIV seropositivity; (3) to measure the effect of an incentive on compliance with HIV-CT referrals; (4) to measure the effect of the incentive on the number of new HIV-infected patients identified; (5) to measure the effect of the incentive on the number of HIV infected patients who enter HIV care: (6) to apply the Health Belief Model to identify barriers which reduce compliance with HIV-CT; and (7) to estimate the cost of this system, per new HIV-infected patient identified. A telephone questionnaire will be used to measure seven Health Belief Model factors which affect health-related behaviors. The influence of each of these factors on compliance with testing will be determined. The results of this project will guide attempts to improve the effectiveness of ED referral systems for HIV-CT by quantifying the effects of barriers to compliance.