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Lockhart E, Turner D, Guastaferro K, Szalacha LA, Alzate HT, Marhefka S, Pittiglio B, Dekker M, Yeh HH, Zelenak L, Toney J, Manogue S, Ahmedani BK. Increasing pre-exposure prophylaxis (PrEP) in primary care: A study protocol for a multi-level intervention using the multiphase optimization strategy (MOST) framework. Contemp Clin Trials 2024; 143:107599. [PMID: 38848935 DOI: 10.1016/j.cct.2024.107599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 05/14/2024] [Accepted: 06/01/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND In the United States, over 1.2 million people are living with HIV. This disease disproportionately affects men who have sex with men (MSM), people of color, youth and young adults, and transgender individuals. Pre-exposure prophylaxis (PrEP) is an effective HIV prevention method. Barriers exist for both primary care providers (PCPs) to prescribe PrEP and prevent patients from initiating PrEP. METHODS This study, MOST: PrEP, follows the multiphase optimization strategy (MOST) framework. The purpose is to identify a multi-level intervention among patients and PCPs to increase PrEP prescriptions in primary care. First, feedback will be obtained from providers and patients via focus groups, then, suggestions related to the context-specific (provider and individual level) factors of intervention component delivery will be incorporated. Subsequently, a rigorous experiment will be conducted using a 24 factorial design focusing on priority populations for PrEP initiation. Provider components include computer-based simulation training and a best practice alert. Patient components include a tailored PrEP educational video and HIV risk assessment. Finally, the facilitators and barriers to implementing the intervention components will be qualitatively examined. CONCLUSION In this protocol paper, we describe the one of the first known multilevel MOST optimization trial in healthcare. Intervention components are to be delivered to patients and providers in a large healthcare system, based in an HIV Ending the Epidemic priority jurisdiction. If effective, this multi-level approach could be disseminated to providers and patients in other large healthcare systems to make a significant impact on HIV prevention.
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Affiliation(s)
- Elizabeth Lockhart
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - DeAnne Turner
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Kate Guastaferro
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 6th Floor Room 636, New York, NY 10003, USA.
| | | | - Herica Torres Alzate
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Stephanie Marhefka
- College of Nursing, University of South Florida, 12912 USF Health Dr, Tampa, FL 33612, USA.
| | - Bianca Pittiglio
- Family Medicine, Henry Ford Health, 110 E 2nd Street, Royal Oak, MI 48067, USA.
| | - Megan Dekker
- Academic Internal Medicine, Henry Ford Health, 2799 W Grand Blvd, Detroit, MI 48202, USA.
| | - Hsueh-Han Yeh
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Logan Zelenak
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Jeremy Toney
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Sean Manogue
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health, 1 Ford Pl., Detroit, MI 48202, USA.
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Aronson ID, Zhang J, Rajan S, Marsch LA, Bugaighis M, Ibitoye MO, Chernick LS, Des Jarlais DC. Automated Substance Use/Sexual Risk Reporting and HIV Test Acceptance Among Emergency Department Patients Aged 13-24 Years. AIDS Behav 2022; 26:1544-1551. [PMID: 34705152 PMCID: PMC9007819 DOI: 10.1007/s10461-021-03507-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 12/28/2022]
Abstract
Despite federal guidelines, many adolescents and emerging adults are not offered HIV testing by their healthcare providers. As such, many-including those who may be at high-risk for contracting HIV given their sexual and/or substance use risk-are not routinely tested. The current study examines sexual risk and substance use among emergency department patients aged 13-24 years (n = 147), who completed an automated screening as part of a tablet-based intervention designed to increase HIV testing. Twenty seven percent (n = 39) of participants chose to test for HIV after completing the tablet-based intervention. Among this sample, sexual risk was a significant independent predictor of HIV testing (χ2 = 16.50, p < 0.001). Problem substance use (e.g. trying but failing to quit) also predicted testing (χ2 = 7.43, p < 0.01). When considering these behaviors together, analyses indicated that the effect of problem substance use (ß = 0.648, p = 0.154) on testing is explained by sexual risk behavior (ß = 1.425, p < 0.01). The study's findings underscore the value of using routine automated risk screenings to collect sensitive data from emergency department patients, followed by computer-based HIV test offers for adolescent youth. Our research indicates tablet-based interventions can facilitate more accurate reporting of sexual behavior and substance use, and can also potentially increase HIV test uptake among those at risk.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, NY, USA.
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA.
| | - Jingru Zhang
- Teachers College, Columbia University, New York, NY, USA
| | - Sonali Rajan
- Teachers College, Columbia University, New York, NY, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, NH, USA
| | - Mona Bugaighis
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | | | - Lauren S Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Don C Des Jarlais
- School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA
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Aronson ID, Bennett AS, Ardouin-Guerrier MA, Rivera-Castellar GJ, Gibson BE, Vargas-Estrella B. Using the participatory education and research into lived experience (PEARLE) methodology to localize content and target specific populations. Front Digit Health 2022; 4:992519. [PMID: 36339513 PMCID: PMC9634163 DOI: 10.3389/fdgth.2022.992519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022] Open
Abstract
Technology-based behavioral health interventions offer potentially limitless opportunities to localize content and target specific populations. However, this ability to customize requires developers to make a wide range of decisions not only about who should appear on screen, but how each message should be refined to most effectively reach a particular group of intervention recipients. These issues become especially salient as interventions are scaled for delivery to multiple populations in different geographical locations or settings (e.g., a hospital emergency department versus the drop-in center of a community-based clinic), and in more than one language. To facilitate evidence-based development of customized, targeted intervention content, our team created a multi-step methodology over a series of NIH-funded research projects. The resulting Participatory Education and Research into Lived Experience (PEARLE) Methodology entails formative qualitative interviews to examine why members of a given population do not enact a specific health behavior such as HIV/HCV testing or vaccinating against COVID-19 (this step includes identifying potential gaps in related health literacy), followed by iterative evaluations of draft content designed to address these barriers, and extensive discussions with a Community Advisory Board. The final step is a clinical trial. PEARLE is designed to be highly flexible, adaptable to a variety of behavioral outcomes in clinical and community settings, and to create content in more than one language depending on the needs or preferences of a population. The current paper discusses how our team employed PEARLE to develop content in English and Spanish for our latest project, which is intended to increase COVID-19 vaccination uptake among people who inject drugs.
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Affiliation(s)
- Ian David Aronson
- Technology-Based Education for Community Health (TECH) Lab, Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Alex S Bennett
- Technology-Based Education for Community Health (TECH) Lab, Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - Mary-Andrée Ardouin-Guerrier
- Technology-Based Education for Community Health (TECH) Lab, Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
| | - German J Rivera-Castellar
- Technology-Based Education for Community Health (TECH) Lab, Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, United States
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Romero RA, Klausner JD, Marsch LA, Young SD. Technology-Delivered Intervention Strategies to Bolster HIV Testing. Curr HIV/AIDS Rep 2021; 18:391-405. [PMID: 34109549 PMCID: PMC8188945 DOI: 10.1007/s11904-021-00565-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/29/2022]
Abstract
Since the beginning of the HIV epidemic, there have been more than 75 million cases. Currently, there about 1.2 million living with HIV in the USA. Despite current testing recommendations, test rates continue to be suboptimal. Investigators have studied the use of digital technology to promote HIV testing, especially among high-risk populations. PURPOSE OF REVIEW: This non-systematic review provides an overview of the scientific research between 2015 and 2020 focused on the use of digital technology to bolster HIV testing and suggests novel technologies for exploration. RECENT FINDINGS: A total of 40 studies were included in the review that span a wide range of available technology. Studies effectively increased HIV testing among study participants. Generally, participants in the intervention/exposure groups had significantly higher rates of HIV test uptake compared to participants in the comparison groups at study follow-up. For a variety of reasons (e.g., differences in ways the technologies were used and study design), no digital tool clearly performed better than others, but each have the capacity to increase outreach and self-testing. An exploration of the potential use of nascent technologies is also discussed, as well as the authors' experiences using a number of these technologies in our research.
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Affiliation(s)
- Romina A Romero
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA
| | - Jeffrey D Klausner
- Division of Disease Prevention, Policy and Global Health, Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Lisa A Marsch
- Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
| | - Sean D Young
- Department of Emergency Medicine, University of California, Irvine, Irvine, CA, USA.
- Department of Informatics, University of California, Irvine, 6091 Bren Hall, Irvine, CA, 92617, USA.
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5
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Aronson ID, Zhang J, Rajan S, Bugaighis M, Marsch LA, Ibitoye M, Chernick LS, Des Jarlais DC. Mobile Augmented Screening to Increase HIV Testing Among Emergency Department Patients as Young as 13 Years. Cureus 2021; 13:e15829. [PMID: 34327070 PMCID: PMC8301293 DOI: 10.7759/cureus.15829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 12/02/2022] Open
Abstract
Because adolescents and emerging adults are frequently not offered HIV testing, and often decline tests when offered, we developed and tested a tablet-based intervention to increase HIV test rates among emergency department (ED) patients aged 13-24 years. Pediatric and adult ED patients in a high volume New York City hospital (N = 295) were randomized to receive a face-to-face HIV test offer, or to complete a tablet-based intervention that contained an HIV test offer delivered via computer. Test rates in both conditions were then compared to historic test rates in the same ED during the previous six months. Among participants aged 19 years and younger who were offered HIV testing and declined before enrollment in the study, participants in the tablet-based condition were 1.7 times more likely to test for HIV compared to participants in the face-to-face condition. Participants aged 19 years and younger were three times as likely to test for HIV compared to patients the same age who were treated in the previous six months (26.39%, n = 71 study participants vs. 10.29%, n = 189 prior patients, OR = 3.13, \begin{document}\chi\end{document}2 = 54.76, p < 0.001). Protocols designed to offer HIV testing to all eligible patients can significantly increase adolescent test rates compared to standard practice. Because tablets are equally effective compared to face-to-face offers, and in some cases more so, EDs may consider tablet-based interventions that require fewer staff resources and may integrate more easily into high-volume workflows.
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Affiliation(s)
- Ian D Aronson
- Research, Digital Health Empowerment, Brooklyn, USA.,Social and Behavioral Sciences, New York University School of Global Public Health, New York, USA
| | - Jingru Zhang
- Measurement and Evaluation, Teachers College, Columbia University, New York, USA
| | - Sonali Rajan
- Department of Health and Behavior Studies, Teachers College, Columbia University, New York, USA
| | - Mona Bugaighis
- Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Dartmouth College, Lebanon, USA
| | - Mobolaji Ibitoye
- Institute for Population Research, The Ohio State University, Columbus, USA
| | - Lauren S Chernick
- Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Don C Des Jarlais
- Epidemiology, New York University School of Global Public Health, New York, USA
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6
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Aronson ID, Zhang J, Rajan S. The importance of content and choice in a technology-based intervention to increase HIV testing. INTERNATIONAL JOURNAL OF HEALTH PROMOTION AND EDUCATION 2021; 59:354-365. [PMID: 35173555 PMCID: PMC8845491 DOI: 10.1080/14635240.2021.1918568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/14/2021] [Indexed: 06/14/2023]
Abstract
Although the Centers for Disease Control and Prevention recommends routine HIV testing in emergency departments and other facilities, many patients are never offered testing, and those who are offered testing frequently decline. In response, our team developed and evaluated a series of differently configured technology-based interventions to explore how we can most effectively increase HIV testing among reluctant patients. The current study examines how different videos (onscreen physician vs. onscreen community member), and different intervention configurations (enabling some participants to select a video while others are assigned to watch a video or to view bullet-point text), could potentially increase self-efficacy to test for HIV among patients who had never tested. Analyses of data from 285 emergency department patients in New York City who declined HIV testing offered by hospital staff indicated that participants reported highly significant differences in self-efficacy depending on their history of previous testing, whether they were enabled to select a video or were assigned a video, and which video they watched. Participants who reported no previous testing reported significantly lower pre-test self-efficacy compared to those who had tested at least once before. Among those who had not previously tested, the greatest pre-post increases in self-efficacy were reported by participants who were randomly enabled to select an intervention video and chose to watch video depicting a physician. Our findings highlight the importance, not only of intervention content, but how that content is delivered to specific participants. These findings may inform more effective technology-based behavioral health interventions.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, USA
- School of Global Public Health, New York University, New York, USA
| | - Jingru Zhang
- Teachers College, Columbia University, New York, USA
| | - Sonali Rajan
- Teachers College, Columbia University, New York, USA
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7
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Aronson ID, Freeman R, Taylor T, Bennett AS. Developing Digital Media to Destigmatize Emergency Department Human Immunodeficiency Virus Testing Among Sexual and Racial Minority Youth: A Hyper-iterative Methodology. Cureus 2020; 12:e7209. [PMID: 32269887 PMCID: PMC7138468 DOI: 10.7759/cureus.7209] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 03/07/2020] [Indexed: 11/10/2022] Open
Abstract
Rates of undiagnosed youth human immunodeficiency virus (HIV) remain problematically high across the United States and internationally. In addition, youth HIV test rates remain consistently low, and youth with HIV remain undiagnosed for longer periods of time as compared with older populations. Youth HIV remains especially persistent among African American adolescents and emerging adults, who are less likely to have consistent access to primary care and thus to HIV testing and prevention education. Therefore, increasing youth HIV test rates has become an important priority in emergency departments and other settings. At the same time, many young patients may not disclose risk behaviors or even engage in discussions of HIV testing when they interact with healthcare providers because they may fear being stigmatized. Technology-based interventions present valuable opportunities to reframe risk reporting and discussions of testing by designing computer-mediated interactions that young sexual and racial minority participants find non-judgmental and less threatening. If designed in accordance with empirically tested theories of instructional design/multimedia learning and established models of behavior change, technology-based interventions can increase the number of HIV tests offered to young people and offer testing in nonthreatening ways that more young people will accept. The current paper describes a hyper-iterative methodology used to develop the Mobile Augmented Screening (MAS) tool, a technology-based intervention designed to destigmatize HIV and increase HIV test rates among youth.
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Affiliation(s)
- Ian D Aronson
- Research, Digital Health Empowerment, Brooklyn, USA
- Health Communication, New York University School of Global Public Health, New York, USA
| | | | - Tonya Taylor
- Medicine: Infectious Disease, State University of New York (SUNY) Downstate Medical Center, Brooklyn, USA
| | - Alex S Bennett
- Research, New York University School of Global Public Health, New York, USA
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Aronson ID, Cleland CM, Rajan S, Marsch LA, Bania TC. Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients. AIDS Behav 2020; 24:475-483. [PMID: 31049808 DOI: 10.1007/s10461-019-02517-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
More than 10 years after the Centers for Disease Control and Prevention recommended routine HIV testing for patients in emergency departments (ED) and other clinical settings, as many as three out of four patients may not be offered testing, and those who are offered testing frequently decline. The current study examines how participant characteristics, including demographics and reported substance use, influence the efficacy of a video-based intervention designed to increase HIV testing among ED patients who initially declined tests offered by hospital staff. Data from three separate trials in a high volume New York City ED were merged to determine whether patients (N = 560) were more likely to test post-intervention if: (1) they resembled people who appeared onscreen in terms of gender or race; or (2) they reported problem substance use. Chi Square and logistic regression analyses indicated demographic concordance did not significantly increase likelihood of accepting an HIV test. However, participants who reported problem substance use (n = 231) were significantly more likely to test for HIV in comparison to participants who reported either no problem substance use (n = 190) or no substance use at all (n = 125) (x2 = 6.830, p < 0.05). Specifically, 36.4% of patients who reported problem substance use tested for HIV post-intervention compared to 30.5% of patients who did not report problem substance use and 28.8% of participants who did not report substance use at all. This may be an important finding because substance use, including heavy alcohol or cannabis use, can lead to behaviors that increase HIV risk, such as sex with multiple partners or decreased condom use.
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Tan R, Hugli O, Cavassini M, Darling K. Non-targeted HIV testing in the emergency department: not just how but where. Expert Rev Anti Infect Ther 2018; 16:893-905. [PMID: 30406726 DOI: 10.1080/14787210.2018.1545575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The emergency department (ED) has the potential to enhance early HIV diagnosis through HIV testing programs. How these are implemented is a subject of debate. Areas covered: We describe the main HIV testing approaches: diagnostic testing, targeted screening, and non-targeted screening, and review ED-based non-targeted HIV screening studies conducted after 2006 among ≥5000 patients. As well as examining how testing is offered, we focus on where it is offered, through the patient's journey from registration, via triage and the waiting room, to the bedside. Barriers to the testing offer, acceptance and performance were examined at each location. While testing offer rates were higher at registration and triage, compared to the waiting room and bedside, this was sometimes at the expense of testing acceptance and performance. Variables affecting testing rates included type of consent, employment of external staff and type of testing: fourth generation serological testing versus rapid testing. Expert commentary: These large studies shed light on the importance of where as well as how HIV testing is performed, and the ways in which the 'where' can influence non-targeted screening yields. This perspective enables testing approaches to be tailored to specific ED settings in order to maximize testing rates.
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Affiliation(s)
- Rainer Tan
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Olivier Hugli
- b Emergency Department , Lausanne University Hospital , Lausanne , Switzerland
| | - Matthias Cavassini
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
| | - Katharine Darling
- a Infectious Diseases Service , Lausanne University Hospital , Lausanne , Switzerland
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HIV Testing in the Emergency Department. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2018. [DOI: 10.1007/s40138-018-0161-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Patel AV, Abrams SM, Gaydos CA, Jett-Goheen M, Latkin CA, Rothman RE, Hsieh YH. Increasing HIV testing engagement through provision of home HIV self-testing kits for patients who decline testing in the emergency department: a pilot randomisation study. Sex Transm Infect 2018; 95:358-360. [PMID: 29903889 DOI: 10.1136/sextrans-2018-053592] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/24/2018] [Accepted: 05/20/2018] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Up to 60% of patients decline routine HIV testing offer in US emergency departments (EDs). The objective of this study is to determine whether the provision of HIV self-testing (HIVST) kit would increase engagement of HIV testing among these HIV test 'Decliners'. METHODS Patients who declined a test offered in an ED-based triage nurse-driven HIV screening programme were enrolled and randomised to either the HIVST or the control group. The patients in the HIVST group received HIVST kits to take home, were encouraged to report test results to an established internet-based STI/HIV testing recruitment website 'I Want the Kit' (IWTK) and received five referral cards for their peers to request HIVST kits from IWTK. The control group received pamphlets about publicly available HIV testing sites. HIV testing from both groups after enrolment was determined via telephone follow-up at 1 month. Testing rate ratio (RR) was determined using χ2 tests. RESULTS Fifty-two patients were randomised to the HIVST group and 48 to the control group. Among all 64 patients completing any follow-up, 14/29 (48%) patients in the HIVST group tested themselves at home with the provided kit. Four of these had never had an HIV test. Only 2/35 (6%) in the control group reported having an HIV test after enrolment (RR: 8.45 (95% CI: 2.09 to 34.17)). 57% (8/14) in the HIVST group reported test results to IWTK. CONCLUSION Provision of HIVST kits supplements ED-based screening programme and significantly improved engagement of HIV testing among those test 'Decliners' in the ED. TRIAL REGISTRATION NUMBER NCT03021005, results.
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Affiliation(s)
- Anuj V Patel
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Samuel M Abrams
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Charlotte A Gaydos
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Mary Jett-Goheen
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Carl A Latkin
- Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins School of Public Health, Baltimore, Maryland, USA
| | - Richard E Rothman
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Medicine, Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Zhang Y, Li X, Qiao S, Zhou Y, Shen Z. Information Communication Technology (ICT) use among PLHIV in China: A promising but underutilized venue for HIV prevention and care. INTERNATIONAL JOURNAL OF INFORMATION MANAGEMENT 2018. [DOI: 10.1016/j.ijinfomgt.2017.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Aronson ID, Bennett A, Marsch LA, Bania TC. Mobile Technology to Increase HIV/HCV Testing and Overdose Prevention/Response among People Who Inject Drugs. Front Public Health 2017; 5:217. [PMID: 28879174 PMCID: PMC5572321 DOI: 10.3389/fpubh.2017.00217] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/03/2017] [Indexed: 12/11/2022] Open
Abstract
The United States faces dramatically increasing rates of opioid overdose deaths, as well as persistent ongoing problems of undiagnosed HIV and HCV infection. These problems commonly occur together in substance using populations that have limited, if any, access to primary care and other routine health services. To collectively address all three issues, we developed the Mobile Intervention Kit (MIK), a tablet computer-based intervention designed to provide overdose prevention and response training and to facilitate HIV/HCV testing in community settings. Intervention content was produced in collaboration with experienced street outreach workers who appear onscreen in a series of educational videos. A preliminary pilot test of the MIK in a Bronx, NY street outreach syringe exchange program found the MIK is feasible and highly acceptable to a population of people who inject drugs. Participants accepted HIV and HCV testing post-intervention, as well as naloxone training to reverse overdose events. Pre-post tests also showed significant increases in knowledge of overdose prevention, HIV testing procedures, and asymptomatic HCV infection. Future iterations of the MIK can be optimized for use in community as well as clinical settings nationwide, and perhaps globally, with a focus on underserved urban populations.
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Affiliation(s)
- Ian David Aronson
- National Development and Research Institutes, New York, NY, United States.,Digital Health Empowerment, Brooklyn, NY, United States
| | - Alexander Bennett
- National Development and Research Institutes, New York, NY, United States
| | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Theodore C Bania
- Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke's, New York, NY, United States
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Aronson ID, Guarino H, Bennett AS, Marsch LA, Gwadz M, Cleland CM, Damschroder L, Bania TC. Staff Perspectives on a Tablet-Based Intervention to Increase HIV Testing in a High Volume, Urban Emergency Department. Front Public Health 2017; 5:170. [PMID: 28744454 PMCID: PMC5504145 DOI: 10.3389/fpubh.2017.00170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/26/2017] [Indexed: 12/01/2022] Open
Abstract
Emergency departments (EDs) frequently serve people who have limited, if any, additional interactions with health care, yet many ED patients are not offered HIV testing, and those who are frequently decline. ED staff (n = 13) at a high volume urban ED (technicians, nurses, physicians, and administrators) were interviewed to elicit their perspectives on the feasibility and acceptability of a tablet-based intervention designed to increase HIV test rates among patients who initially decline testing. Content-based thematic analysis of semi-structured interviews indicated overall support for interventions to increase HIV testing, but a lack of available staff resources emerged as a potential barrier to widespread implementation. Also, some ED staff questioned whether it was appropriate to shift responsibility for public health services, such as HIV testing, to the ED instead of a primary care setting. Although tablet-based interventions have been shown effective in high volume ED settings and can potentially increase HIV test rates among hard-to-reach populations, additional effort is now required to better integrate this type of intervention into existing workflows.
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Affiliation(s)
- Ian David Aronson
- National Development and Research Institutes, New York, NY, United States
| | - Honoria Guarino
- National Development and Research Institutes, New York, NY, United States
| | | | - Lisa A Marsch
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth, Lebanon, NH, United States
| | - Marya Gwadz
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, New York, NY, United States
| | - Charles M Cleland
- Center for Drug Use and HIV Research (CDUHR), New York University College of Nursing, New York, NY, United States
| | | | - Theodore C Bania
- Icahn School of Medicine at Mount Sinai, Mount Sinai St. Luke's, Mount Sinai West, New York, NY, United States
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