Increasing HIV Testing in Urban Emergency Departments via Mobile Technology

通过移动技术增加城市急诊科的艾滋病毒检测

基本信息

批准号：
8789217
负责人：
Ian David Aronson
金额：
$ 28.22万
依托单位：
NATIONAL DEVELOPMENT AND RESEARCH INSTITUTES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-07-01 至 2017-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8789217
关键词：
AIDS prevention Accident and Emergency department Address Adult African American Alcohol consumption Alcohol or Other Drugs use Area Behavior Behavioral Blood Caring Centers for Disease Control and Prevention (U.S.)Characteristics Clinical Communities Computers Control Groups Data Emergency Department patient Face Funding Goals HIV HIV Infections HIV Seropositivity HIV diagnosis HIV risk Health Personnel Health Priorities Health Services Accessibility Hispanics Hospitals Human immunodeficiency virus test Incentives Individual Intervention Interview Knowledge Latino Learning Life Literature Measures Modeling Motivation National Institute of Drug Abuse New York New York City Nurse Administrator Nurses Oral Participant Patients Persons Phase Physicians Population Prevalence Process Qualitative Methods Randomized Recruitment Activity Reporting Research Research Personnel Risk Solutions Staging Technology Testing Text Treatment Efficacy Triage Underserved Population Urban Hospitals Variant Vulnerable Populations Work aged arm base behavior change brief intervention computerized cost demographics design disorder prevention experience high risk improved member motivated behavior post intervention public health relevance randomized trial screening skills therapy design

项目摘要

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.

描述（由申请人提供）：由于未确诊的艾滋病毒患者不会接受治疗，并且可能会在不知不觉中感染他人，因此我们建议采用基于移动计算机的视频干预措施，以提高高流量城市医院急诊科 (ED) 的艾滋病毒检测率。急诊室为许多艾滋病毒高危人群提供了重要的接触点。不幸的是，当急诊科患者接受常规艾滋病毒检测时，大多数人都拒绝了。我们提出的干预措施是基于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结果。该干预措施以信息动机和行为技能模型 (IMB) 为基础，屏幕上的医生解释了 HIV 检测（以建立知识和动机）的重要性，并对快速 HIV 检测进行建模（以提高动机和行为技能）。这个简短的干预产生了强有力的效果：第三个接受了艾滋病毒干预后测试。虽然这项初步研究非常令人鼓舞，但它也揭示了许多其他关键的研究问题。首先，目前尚不清楚哪种干预措施对患者做出检测决定影响最大：视频内容或由计算机而不是人提供的艾滋病毒检测。其次，与文献一致，参与者表示，社区成员在屏幕上披露艾滋病毒阳性状况会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）对行为的影响程度存在个体差异。因此，本研究的目标是在 IMB 模型的指导下，确定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 HIV 检测率。本研究将采用试点四臂随机对照设计。所有参与者将使用移动数据终端完成测试前评估（社会人口统计、艾滋病毒测试知识、物质使用筛查）。一只手臂将看到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）。第二只手臂将观看社区成员的视频，该成员解释了测试的重要性、模型测试并透露他是艾滋病毒阳性。第三个人可以选择观看两个视频中的哪一个。第四组（对照组）不会看到任何视频。在计算机化干预结束时（预测试/视频或仅预测试），屏幕上显示文本将询问患者是否同意进行艾滋病毒检测。同意的人将接受急诊室工作人员的测试。该试验将在纽约市圣卢克医院中心的急诊室招募 18-64 岁的患者（N=300）。该机构每年为大约 100,000 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。该研究的目的是设计、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。该研究的终点将是干预后的艾滋病毒检测率。另一个目标是更好地了解患者对干预的体验，并利用定性方法征求工作人员对实施的看法。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。