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

项目摘要 成人急诊科（艾德）HIV/HCV筛查成功的一个主要障碍是， 艾德患者有HIV和HCV下降检测的风险，或后来被诊断为HIV和HCV下降检测。然而，对于那些 拒绝HIV/HCV筛查，没有循证干预措施来说服他们接受检测。 为了应对增加艾德HIV/HCV筛查接受度的干预措施的不足，我们最近 完成了一个R34项目，在此期间，我们开发了一个有说服力的健康沟通干预（PHCI） 在利益相关者的帮助下（艾德患者、HIV/HCV咨询师和艾德医务人员）。在两项试点研究中，我们 研究了PHCI在最初拒绝HIV/HCV筛查的成人艾德患者中的疗效。在一个 在一项初步研究中，成年艾德患者被分配观看控制条件视频更有可能同意接受测试 接受HIV/HCV咨询师亲自进行PHCI的患者（n=56，27% vs. 10%; 10.17%，10.95% CI： 6-32%）。然而，在一项单独的初步研究中，成年艾德患者被随机分配观看一段视频， 向艾德患者提供PCHI的医生比那些观察者更有可能同意接受测试 对照条件视频（n=60，29% vs. 11%; ≥ 18%，≥ 95% CI：7-35%）。这些结果表明，PHCI 视频可能会增加HIV/HCV筛查的接受程度，超过HIV/HCV感染者亲自提供的PHCI。 律师如果这些结果在更大规模的研究中得到证实，PHCI视频可以更广泛地使用 PHCI和促进更广泛地接受艾德HIV/HCV筛查。不幸的是，在我们的R34项目中，我们没有 在当前和以前的注射毒品者（PWID）中开发或评估PHCI。因此， 当前的PHCI可能不足以说服当前/以前的PWID进行测试，因此需要 在当前/以前的PWID的帮助下进行修改，以便对这些非常高的HIV/HCV风险患者有效。 在本R 01项目中，我们首先将使用当前/以前PWID的输入修改PHCI。接下来我们就 进行一项随机对照试验（RCT），比较PHCI通过视频与 HIV/HCV咨询师。拒绝HIV/HCV筛查的成人艾德患者将按IDU病史分层：（1） 当前/以前的PWID或（2）从未/非PWID。在每一层中，我们将随机分配 参与者接受由（1）视频（2）HIV/HCV顾问提供的PHCI。当前/以前的PWID将收到 针对PWID修改的PHCI，而从不/非PWID将接收未修改的原始PHCI版本。 对于目标1，我们将确定哪种PHCI交付形式（视频或HIV/HCV顾问）会带来更多成果 接受HIV/HCV筛查的艾德患者，与其IDU史无关。对于目标2，我们将确定 哪种PHCI给药形式导致更多艾德患者在每个IDU内接受HIV/HCV筛查 历史队列（当前/既往PWID，从未/非PWID），以及IDU之间的测试验收是否相似 历史上的coholds对于目标3，我们将通过卫生经济学进一步比较两种PHCI给药形式 评估，独立于IDU历史和每个IDU历史队列。

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.