Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

描述(申请人提供)：由于未确诊的艾滋病毒携带者将不会接受治疗，并可能在不知不觉中感染他人，我们建议采用基于移动计算机的视频干预，以提高大容量城市医院急诊科的艾滋病毒检测率。EDS为许多感染艾滋病毒风险最高的人提供了重要的接触点。不幸的是，当ED患者被提供常规的HIV检测时，大多数人都拒绝了。我们建议的干预措施建立在我们的研究团队对拒绝艾滋病毒检测的患者进行的一项试验的初步发现的基础上。这项干预以信息-动机和行为技能模型(IMB)为基础，展示了一名屏幕医生解释艾滋病毒检测(建立知识和动机)的重要性，并模拟快速艾滋病毒检测(以增加动机和行为技能)。这一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 测试干预后的结果。虽然这项初步研究非常令人鼓舞，但它揭示了一些其他关键的研究问题。首先，目前尚不清楚哪些干预因素对患者做出检测决定的贡献最大：是视频内容，还是由计算机而不是人工提供艾滋病毒检测。其次，与文献一致的是，参与者表示，社区成员在屏幕上披露艾滋病毒阳性状态将增加接受检测的患者比例。第三，结果表明，屏幕上的社区成员或专家(例如医生)对行为影响更大的程度存在个体差异。因此，在IMB模型的指导下，本研究的目标是确定我们如何改进基于移动计算机的干预措施，以最大限度地提高最初拒绝在急诊室进行检测的患者的艾滋病毒检测率。本研究将采用试验性四臂随机对照设计。所有参与者将使用移动计算机完成测试前评估(社会人口学、艾滋病毒测试知识、药物使用筛查)。一只手臂将看到一名医生解释艾滋病毒检测和快速检测建模的重要性的视频(类似于原始视频)。第二个手臂将观看一名社区成员的视频，该成员解释检测的重要性，模拟检测，并透露自己是艾滋病毒阳性。三分之一的人可以选择观看这两个视频中的哪一个。第四组(对照组)将看不到任何视频。在计算机干预结束时(仅限测试前/视频或测试前)，屏幕上的文本 将询问患者是否同意艾滋病毒检测。那些同意的人将接受教育署工作人员的测试。该试验将在纽约市圣卢克医院中心急诊室招募年龄为18-的患者(N=300)。该中心每年为大约10万名患者提供服务，其中大约45%是黑人或非裔美国人，40%是西班牙裔或拉丁裔。这项研究的目的是设计、开发、测试和评估一套完善的基于移动计算机的干预组件，包括简短的视频。这项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患者对干预的体验，并使用定性方法引发员工对实施的看法。我们的研究将为全国范围内服务不足的人群提供可扩展的干预措施。

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.