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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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2
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Marcu G, Ondersma SJ, Spiller AN, Broderick BM, Kadri R, Buis LR. The Perceived Benefits of Digital Interventions for Behavioral Health: Qualitative Interview Study. J Med Internet Res 2022; 24:e34300. [PMID: 35353045 PMCID: PMC9008533 DOI: 10.2196/34300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/09/2021] [Accepted: 12/30/2021] [Indexed: 01/20/2023] Open
Abstract
Background Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-, and expertise-related challenges in digital intervention development. Improving the availability of tools and guidance for researchers will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. Objective This study aims to understand the perceptions of behavioral researchers toward digital interventions, and inform the use of these interventions, by documenting the reasons why researchers are increasingly focusing their efforts on digital interventions and their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. Methods We conducted semistructured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from the interviews were transcribed and thematically analyzed by multiple coders. Results Interviews were completed with 18 individuals and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project or study staff. Four major themes came out of the interviews concerning the benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients, support for implementing evidence-based interventions with fidelity, scaling and improving access to interventions, and getting a foot in the door despite stigma and disenfranchisement. Conclusions Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability of digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike.
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Affiliation(s)
- Gabriela Marcu
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | - Steven J Ondersma
- Department of Obstetrics, Gynecology, & Reproductive Biology and the Division of Public Health, Michigan State University, East Lansing, MI, United States
| | - Allison N Spiller
- School of Information, University of Michigan, Ann Arbor, MI, United States
| | | | - Reema Kadri
- Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Lorraine R Buis
- School of Information, University of Michigan, Ann Arbor, MI, United States.,Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States
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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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Ibitoye M, Lappen H, Freeman R, Jordan AE, Aronson ID. Technology-Based Interventions to Increase Point-of-Care HIV Testing and Linkage to Care Among Youth in the US: A Systematic Review. AIDS Behav 2021; 25:1829-1838. [PMID: 33231846 PMCID: PMC7684145 DOI: 10.1007/s10461-020-03112-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2020] [Indexed: 12/28/2022]
Abstract
HIV testing rates remain low among youth ages 13-24 in the US, with only 55% of HIV-positive youth aware of their serostatus. We conducted a systematic review to assess the utility of technology-based interventions to increase point-of-care youth HIV testing and linkage to care. We searched PubMed, Embase, CINAHL, and Cochrane CENTRAL for randomized controlled trials of technology-based interventions aimed at increasing point-of-care youth HIV testing, published between 2008 and 2020. All identified citations were independently screened for inclusion by two authors, and the Cochrane Risk of Bias Tool for Randomized Controlled Trials was used to assess the quality of included studies. Three studies met all inclusion criteria. Two interventions were effective in increasing HIV testing, while one was effective at linkage to care. Technology-based interventions have the potential to increase youth HIV testing in clinical settings and facilitate linkage to care, possibly reducing undiagnosed HIV among adolescents and emerging adults.
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Affiliation(s)
- Mobolaji Ibitoye
- Digital Health Empowerment, 420 12th Street, Brooklyn, NY, 11215, USA.
- Institute for Population Research, The Ohio State University, Columbus, OH, USA.
| | - Hope Lappen
- Division of Libraries, New York University, New York, NY, USA
| | - Robert Freeman
- Digital Health Empowerment, 420 12th Street, Brooklyn, NY, 11215, USA
| | - Ashly E Jordan
- Center for Drug Use and HIV/HCV Research, New York University, New York, NY, USA
- Behavioral Science Training in Drug Abuse Research, New York University, New York, NY, USA
| | - Ian David Aronson
- Digital Health Empowerment, 420 12th Street, Brooklyn, NY, 11215, USA
- Center for Drug Use and HIV/HCV Research, New York University, New York, NY, USA
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Aronson ID, Bennett AS, Freeman R. Toward a human-centered use of technology: a stakeholder analysis of harm reduction and CBO staff. Harm Reduct J 2020; 17:77. [PMID: 33076911 PMCID: PMC7570409 DOI: 10.1186/s12954-020-00422-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 10/06/2020] [Indexed: 11/16/2022] Open
Abstract
Background Technology can enable syringe service programs (SSPs) and other community-based organizations (CBOs) operating under a harm reduction framework to work with an increased number of clients and can also enable organizations to offer services more effectively (e.g., offering HIV testing in ways participants may be more likely to accept). In the current time of COVID-19 social distancing, technology can also help organizations more safely provide services to people with compromised immune systems and to clients who might otherwise not be reached. However, technology projects implemented in harm reduction settings are frequently conceptualized and developed by researchers or technology specialists rather than by SSP staff or clients. Methods To more effectively meet the needs of SSPs and other CBOs across the USA, our team conducted qualitative interviews with 16 individuals who have extensive backgrounds working in the field of harm reduction. Interviews were digitally recorded and professionally transcribed, and the transcripts were checked for accuracy by the interviewers. The resulting transcripts were coded and analyzed to determine emerging themes. Results Interviewees mentioned the ability of technology to deliver consistent quality messaging to multiple clients at the same time and the potential to customize or tailor technology-based messaging to specific client populations as positive benefits. Clear barriers to technology use also emerged, in particular regarding privacy, data security, and the need to maintain client trust when discussing sensitive issues (e.g., illicit drug use). Conclusions Technology offers the potential to deliver consistently high-quality health communication and maintain contact with clients who may have no other access to care. If designed and managed effectively, technology can also address issues related to providing services during times when physical contact is limited due to COVID-19 social distancing measures.
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Affiliation(s)
- Ian David Aronson
- Digital Health Empowerment, Brooklyn, USA. .,New York University, School of Global Public Health, New York, USA.
| | - Alex S Bennett
- Digital Health Empowerment, Brooklyn, USA.,New York University, School of Global Public Health, New York, USA
| | - Robert Freeman
- New York University, School of Global Public Health, New York, USA
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