Development and Pilot Testing of a Persuasive Health Communication Intervention for Emergency Department Patients Who Decline Rapid HIV/HCV Screening

项目摘要 急诊科（ED）是进行HIV和HCV筛查的理想场所， 艾德患者中HIV和HCV冒险行为的流行率（例如，性风险和吸毒， 特别是在美国目前阿片类药物流行期间使用注射药物）;已知的可行性和 艾滋病毒和HCV筛查在这种情况下的可接受性;确定那些未确诊的 艾德中的感染;以及将感染者与艾德就诊后的后续护理联系起来的能力。 对ED患者进行两种感染的筛查是优选的，因为：（1）HIV的一些危险行为的共同重叠 和HCV获得（例如，（2）这些感染在某些国家的共同发生率相对较高 （3）更复杂的医疗需求和并发感染者更严重的后遗症，以及（4）效率。 尽管艾德HIV/HCV筛查有很强的理由，但如何进行筛查的最佳做法， 最大限度地提高患者筛查率尚待确定。两个重要的未解之谜 特别是限制了我们的理解和阻碍筛选工作：（1）我们如何说服患者， 拒绝接受HIV/HCV筛查？以及（2）谁应该进行筛查，以最大限度地进行筛查 摄取？在当前的R34项目中，我们将为后续的R 01进行关键的准备工作 随机对照试验（RCT）旨在解决有关艾德HIV/HCV筛查的这两个未解答的问题。 就目的1而言，我们会进一步发展和改善具说服力的健康沟通措施， 说服拒绝接受HIV/HCV快速筛查的艾德患者接受检测。我们将提交我们的草案 说服性健康传播干预：（a）将提供干预的人（即，艾德医务人员和 HIV/HCV顾问）和（B）预期接受者（即，快速拒绝退出的成人艾德患者 HIV/HCV筛查）。我们将根据这些利益相关者的意见，以迭代的方式改进干预措施。 关于其说服力、可接受性和尊重自主性的观点和建议。 就目的2而言，我们会进行R34试验性随机试验，以评估劝喻式健康教育的可行性和可接受性。 传播干预，并估计其在增加艾滋病毒/HCV筛查中的初步疗效， 拒绝退出HIV/HCV筛查的成年艾德患者。作为干预措施初始效果的主要衡量标准， 增加艾德患者接受HIV/HCV检测的有效性，我们将把干预措施与一个简短的视频进行比较 根据疾病控制和预防中心（CDC）的小册子，提供信息，鼓励 HIV和HCV检测作为干预初始疗效的次要指标，我们将比较艾德 由HIV/HCV咨询师与艾德医务人员进行HIV/HCV检测的接受率。我们的工作 假设是，干预将比视频更有效，并且当 由艾德医疗人员提供。这项R34试点研究将证实 干预，并为后续R 01 RCT提供效应量估计值。

Project Summary Emergency departments (EDs) are an ideal venue to conduct screening for both HIV and HCV, given the high prevalence of HIV and HCV risk-taking behaviors among ED patients (e.g., sexual risk and drug use, particularly injection-drug use during the current opioid epidemic in the US); the known feasibility and acceptability of HIV and HCV screening in this setting; the proven yield of identifying those with undiagnosed infections in the ED; and the ability to link those with infections to subsequent care after the ED visit. Screening for both infections in EDs is preferable due to: (1) the shared overlap of some risk behaviors for HIV and HCV acquisition (e.g., drug use), (2) the relatively high co-occurrence of these infections in some populations, (3) the more complex medical needs and worse sequelae for those co-infected, and (4) efficiency. Despite the strong rationale for ED HIV/HCV screening, best practices on how to conduct screening so to maximize patient screening uptake have yet to be identified. Two important unanswered questions in particular limit our understanding and impede screening efforts: (1) How can we convince patients who decline HIV/HCV screening to be tested? and (2) Who should conduct screening to maximize screening uptake? In this current R34 project, we will conduct crucial preparatory work for a subsequent R01 randomized, controlled trial (RCT) to address these two unanswered questions on ED HIV/HCV screening. For Aim 1, we will further develop and refine a persuasive health communication intervention designed to convince ED patients who decline opt-out rapid HIV/HCV screening to be tested. We will present our draft persuasive health communication intervention to: (a) those who will deliver it (i.e., ED medical staff and HIV/HCV counselors) and to (b) the intended recipients (i.e., adult ED patients who decline opt-out rapid HIV/HCV screening). We will improve the intervention in an iterative fashion based on these stakeholders' perspectives and suggestions regarding its persuasiveness, acceptability, and respect for autonomy. For Aim 2, we will conduct a R34 pilot RCT to assess the feasibility and acceptability of the persuasive health communication intervention and estimate its initial efficacy in increasing HIV/HCV screening uptake among adult ED patients who decline opt-out HIV/HCV screening. As a primary measure of the intervention's initial efficacy in increasing ED patient uptake of HIV/HCV testing, we will compare the intervention to a brief video based on Centers for Disease Control and Prevention (CDC) brochures that provides information to encourage HIV and HCV testing. As a secondary measure of the intervention's initial efficacy, we will compare ED HIV/HCV testing uptake when it is delivered by HIV/HCV counselors vs. ED medical staff. Our working hypotheses are that the intervention will be more efficacious than the video, and more efficacious when delivered by ED medical staff. This R34 pilot study will confirm the feasibility and acceptability of the intervention, and provide effect sizes estimates for the subsequent R01 RCT.