7/1/2014 - 6/30/18
Ian David Aronson, PhD
Our proposed intervention builds upon initial findings from a trial our research team conducted with patients who declined HIV testing. The 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. Second, consistent with the literature, participants indicated that depicting a community member onscreen would increase the proportion of patients who test. Third, results suggest there is individual variation in 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 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. 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 and models testing. 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 a high volume, urban hospital center. The study’s endpoint will be post-intervention HIV test rates. Our study will inform scalable interventions for underserved populations nationwide.
Public Health Relevance
When hospital emergency departments (EDs) offer routine HIV testing to reach substance users and other high-risk patients, those who could benefit most frequently decline. Thus, an important health priority remains not only offering HIV testing to more patients, but developing strategies to increase test rates by working with patients who are reluctant to learn their HIV status. The proposed research will develop and evaluate the acceptability, feasibility, and preliminary efficacy of a mobile computer-based video intervention designed to increase HIV test rates among vulnerable patients in EDs and other high volume clinical settings nationwide.