Optimizing Computer-Based Video to Increase HIV Testing in Emergency Departments

NIDA, R03DA031603

3/15/11 – 10/28/13

Ian David Aronson, PhD

Lisa A. Marsch, PhD, Senior Mentor, CTBH, Dartmouth College; Theodore C. Bania, MD, MS, Co-Investigator, St. Luke’s – Roosevelt Hospital Center, Columbia University

This project will develop and conduct a preliminary evaluation of a computer-based video intervention designed to increase HIV test acceptance in hospital emergency departments (EDs) across the United States. People most in need of HIV testing and prevention education, including drug users and other HIV-infected individuals who are unaware of their infection status, often have little or no access to healthcare outside the ED. Due to ED staff limitations, most notably time and an already heavy workload, many EDs are not able to offer all patients a test or adequately provide necessary pre-test information. Further, because HIV testing is voluntary, patients at highest risk may decline. Undiagnosed cases of HIV present a significant public health problem, as people who do not know they are infected cannot receive treatment, and may unknowingly spread HIV to others. The intervention developed in this study can be used not only to offer HIV testing to more patients, but to increase the number of patients who agree to be tested.

The proposed intervention will employ computer-based video that communicates standardized public health messages in ways patients understand. A video portraying a skilled provider engagingly explaining the importance of HIV testing can be individually delivered on handheld computers to all patients in an ED, while making only minimal personnel demands. Because viewing a video does not require reading, videos are especially suited to lower-literacy populations that seek care in an ED.

The Centers for Disease Control and Prevention recommend routine HIV testing in emergency departments (EDs) because people who visit an ED may lack access to other forms of healthcare, and if they are not tested for HIV, may be infected for years before receiving a diagnosis. Unfortunately, current testing efforts often fail to reach those most at risk. This study will develop and evaluate the acceptability, feasibility and preliminary effectiveness of an automated, computer-based video intervention, which offers considerable promise for increasing HIV test acceptance in EDs across the United States, thus having a marked public health impact.