Persuasive Health Communication Intervention for HIV/HCV

Official title

Evaluation of a Persuasive Health Communication Intervention Designed to Increase HIV/HCV Screening Among Emergency Departments Patients Who Currently, Formerly or Never Injected Drugs.

Overview

A major impediment to emergency department (ED)-based HIV/HCV screening success is that often ED patients at risk for, or later diagnosed with, HIV and HCV decline testing. In this R01 project, the research team will assess how well a promising, easy-to-use, one-time, minimal-training-needed, very brief persuasive health communication intervention (PHCI) increases acceptance of testing among adult ED patients who either currently, formerly or never injected drugs and initially declined HIV/HCV screening. The research team will conduct a randomized, controlled trial (RCT) at EDs within the Mount Sinai Health System to compare the efficacy of the PHCI when delivered by a video vs. an HIV/HCV counselor. Patients who initially declined HIV/HCV screening will be stratified by injection-drug use (IDU) history cohorts: (1) current/former PWIDs, (2) never/non-PWIDs. Within each IDU history cohort, the research team will randomly assign participants (1:1:1) to a PHCI delivered by: (1) a video with captions, (2) a video without captions, (3) an HIV/HCV counselor. This R01 project will be conducted at Mount Sinai affiliate hospitals EDs. For Aim 2, the research team will determine if screening acceptance is similar across IDU history cohorts. For Aim 3, the research team will further compare the two delivery forms of the PHCI through a health economics assessment, both independent of IDU history and within each IDU history cohort.

Detailed description

As part of routine practice at Mount Sinai Health System EDs, the ED Nurses initiate HIV/HCV screening for all patients able to provide consent. ED patients eligible for recruitment into the RCT portion of the study are those who declined HIV/HCV screening. RCs will review the electronic health records (EHRs) of patients present in the ED during data collection periods and determine which patients are potentially eligible.

Participation in the RCT involves a one-time encounter. All research-related activities will occur in the ED. As such, drop-out during this brief RCT (\<30 minutes from recruitment through final study questionnaires) is expected to be minimal (\<5%). RCs will coordinate with participants and ED staff to facilitate participant involvement while they are receiving medical care. If necessary, participants can continue participating in designated areas of the ED (e.g., waiting room, family room) after they are discharged and there are study-related tasks remaining. There are no research related follow-ups needed.

The research team will enroll a total of 2,000 adult ED patients who meet all study criteria and agree to participate in the RCT, stratified by IDU history. Assuming 0.6 participants completing the study/hour (1 study completion/75 minutes of recruitment, enrollment, and data collection), the research team could recruit up to ≈5,184 participants (720 collection days x 12 hours/data collection/day x 0.6 participants/hour) over 3 years.

The research team will be collecting data using the QDS™ (NOVA Research Company) program installed on a tablet computer. The program has the ability to encrypt collected data, to which only the researcher has ability to de-crypt data sets (NOVA Research cannot recover lost passwords for the researcher). The program also has a data management system, allowing data export for use in analytical packages like SPSS, Stata. Internet access is not necessary for this program to function. The data can be stored on the tablet computer for the meantime, then synced once internet is available.

Interventions

• Other Video Format with Captions
  A video with captions created by the research team will be played to persuade patients to participate in HIV and Hepatitis C (HCV) screening.
• Other Video Format without Captions
  A video without captions created by the research team will be played to persuade patients to participate in HIV and Hepatitis C (HCV) screening.
• Other Health Educator
  The video created by the research will be compared to a healthcare provider in terms of effectiveness in getting patients screened for HIV/HCV.

Primary outcome measures

• Number of patients who accept HIV/HCV testing after watching the video with captions [Time frame: Day 1, up to 5 minutes after intervention]
• Number of patients who accept HIV/HCV testing after watching the video without captions [Time frame: Day 1, up to 5 minutes after intervention]
• Number of patients who accept HIV/HCV testing after speaking with a health educator [Time frame: Day 1, up to 5 minutes after intervention]

Secondary outcome measures (4)

• The number of patients that accept HIV/HCV testing by no prior injection-drug use [Time frame: Day 1, up to 5 minutes after intervention]
• The number of patients that accept HIV/HCV testing by former injection-drug use [Time frame: Day 1, up to 5 minutes after intervention]
• The number of patients that accept HIV/HCV testing by current injection-drug use [Time frame: Day 1, up to 5 minutes after intervention]
• Health economics assessment of PHCI [Time frame: End of study, at 5 years]

Eligibility criteria

Inclusion criteria

• ≥18 years-old
• Speak English or Spanish, and able to provide informed consent for study participation
• Not HIV AND HCV infected/Antibody+ (per EHR review and patient report)
• Not already participating in a HIV or HCV study (e.g., HIV PrEP, HIV vaccine)
• Not tested for HIV OR HCV within the past 12 months (per EHR review and patient report)

Exclusion criteria

• <18 years old
• Unable to speak Spanish or English
• HIV or HCV positive
• Currently enrolled in another HIV or HCV research study
• Has tested for HIV or HCV in the past 12 months

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Health services research

Study locations

United States · 1 center

• Icahn School of Medicine at Mount Sinai — New York

Publications

• Merchant RC, Harrington N, Clark MA, Liu T, Morgan J, Cowan E, Solnick R, Wyler B. Testing a persuasive health communication intervention (PHCI) for emergency department patients who declined rapid HIV/HCV screening: a randomised controlled trial study protocol. BMJ Open. 2024 Aug 12;14(8):e089265. doi: 10.1136/bmjopen-2024-089265. PMID 39134444

Identifiers

NCT: NCT05968573 · STUDY-22-01162 · 1R01DA055533-01

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗