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

项目总结 成人急诊科(ED)艾滋病毒/丙型肝炎筛查成功的一个主要障碍是 有艾滋病毒和丙型肝炎病毒感染风险的ED患者拒绝检测。然而，对于那些 拒绝艾滋病毒/丙型肝炎病毒筛查，没有基于证据的干预措施说服他们接受检测。 为了应对提高ED艾滋病毒/丙型肝炎筛查接受率的干预措施的缺陷，我们最近 完成了R34项目，在此期间我们开发了说服性健康沟通干预(PHCI) 在利益相关者的帮助下(ED患者、艾滋病毒/丙型肝炎顾问和ED医务人员)。在两项试点研究中，我们 研究了PHCI在最初拒绝艾滋病毒/丙型肝炎筛查的成年ED患者中的疗效。合而为一 一项初步研究显示，被分配观看控制状态视频的成年ED患者更有可能同意接受测试 比那些从艾滋病毒/丙型肝炎顾问那里亲自接受预防措施的人(n=56，27%比10%；∆17%，∆95%CI： 6-32%)。然而，在另一项试点研究中，成年ED患者被随机分配观看一段视频 将PCI交付给ED患者的医生比观看者更有可能同意接受测试 对照条件视频(n=60，29%比11%；∆18%，∆95%CI：7~35%)。这些结果表明，PHCI 视频可能会比艾滋病毒/丙型肝炎病毒亲自提供的PHCI更能提高艾滋病毒/丙型肝炎病毒筛查的接受度 律师。如果这些结果在更大的研究中得到证实，PHCI视频可能会使 并促进更广泛地接受ED艾滋病毒/丙型肝炎筛查。不幸的是，在我们的R34项目中，我们没有 在现任和前任注射吸毒者(PWID)中开发或评估PHCI。因此， 目前的PHCI可能不足以说服当前/以前的PWID进行测试，因此需要 在现任/前任PWID的帮助下进行修改，以有效地治疗这些艾滋病毒/丙型肝炎风险极高的患者。 在此R01项目中，我们将首先使用来自当前/以前的PWID的输入修改PHCI。接下来，我们将 进行一项随机对照试验(RCT)，比较PHCI通过视频和 艾滋病毒/丙型肝炎顾问。拒绝艾滋病毒/丙型肝炎筛查的成年ED患者将按注射吸毒史进行分层：(1) 现任/前任PWID或(2)从不/非PWID。在这些阶层中，我们将随机分配 参加由(1)视频(2)艾滋病毒/丙型肝炎病毒顾问提供的PHCI的参与者。现任/前任PWID将收到 PHCI针对PWID进行了修改，而从不/非PWID将收到未经修改的原始PHCI版本。 对于目标1，我们将确定哪种PHCI(视频或艾滋病毒/丙型肝炎顾问)的交付形式会带来更多 接受艾滋病毒/丙型肝炎筛查的ED患者，与他们的静脉注射吸毒史无关。对于目标2，我们将确定 哪种PHCI的提供形式会导致更多的ED患者在每个IDU接受艾滋病毒/丙型肝炎筛查 历史队列(当前/以前的PWID，从不/非PWID)，以及各IDU之间的测试接受度是否相似 历史编队。对于目标3，我们将从卫生经济学的角度进一步比较两种PHCI提供形式 评估，既独立于注射吸毒史，也在每个注射吸毒史队列内。

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.