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Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients

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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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References

  1. Dailey AF, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays—United States. MMWR Morb Mortal Wkly Rep. 2017;66(47):1300–6.

    Article  PubMed  PubMed Central  Google Scholar 

  2. KFF. Percentage of persons aged 18–64 who reported ever receiving an HIV test. 2018. https://www.kff.org/other/state-indicator/hiv-testing-rate-ever-tested/?currentTimeframe=4&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D. Accessed 7 Feb 2019.

  3. Hall HI, et al. Prevalence of diagnosed and undiagnosed HIV infection—United States, 2008–2012. MMWR Morb Mortal Wkly Rep. 2015;64(24):657–62.

    PubMed  PubMed Central  Google Scholar 

  4. Gardner EM, Haukoos JS. At the crossroads of the HIV care continuum: emergency departments and the HIV epidemic. Ann Emerg Med. 2015;66(1):79–81.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ku BS, et al. Factors associated with use of urban emergency departments by the U.S. homeless population. Public Health Rep. 2010;125(3):398–405.

    Article  PubMed  PubMed Central  Google Scholar 

  6. D’Onofrio G, et al. Emergency department-initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial. JAMA. 2015;313(16):1636–44.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Hsieh YH, et al. Evaluation of hidden HIV infections in an urban ED with a rapid HIV screening program. Am J Emerg Med. 2016;34(2):180–4.

    Article  PubMed  Google Scholar 

  8. Zucker J, et al. Identifying areas for improvement in the HIV screening process of a high-prevalence emergency department. AIDS Patient Care STDS. 2016;30(6):247–53.

    Article  PubMed  Google Scholar 

  9. Haukoos JS. The impact of nontargeted HIV screening in emergency departments and the ongoing need for targeted strategies. Arch Intern Med. 2012;172(1):20–2.

    Article  PubMed  Google Scholar 

  10. Torian LV, et al. Undiagnosed HIV and HCV infection in a New York City emergency department, 2015. Am J Public Health. 2018;108(5):652–8.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Czarnogorski M, et al. The prevalence of undiagnosed HIV infection in those who decline HIV screening in an urban emergency department. AIDS Res Treat. 2011;2011:879065.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Christopoulos KA, et al. Understanding patient acceptance and refusal of HIV testing in the emergency department. BMC Public Health. 2012;12:3.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Ubhayakar ND, et al. Risk, reasons for refusal, and impact of counseling on consent among ED patients declining HIV screening. Am J Emerg Med. 2011;29(4):367–72.

    Article  PubMed  Google Scholar 

  14. Health, N.Y.S.D.O. Frequently asked questions regarding the HIV testing law. 2012. http://www.health.ny.gov/diseases/aids/providers/testing/law/faqs.htm. Accessed 27 April 2015

  15. Aronson ID, Marsch LA, Rajan S, Koken J, Bania TC. Computer-based video to increase HIV testing among emergency department patients who decline. AIDS Behav. 2015;19:516–22.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Aronson ID, et al. Increasing HIV testing among emergency department patients aged 18–24 years, who initially decline, in National HIV Prevention Conference. GA: Atlanta; 2015.

    Google Scholar 

  17. Dorell CG, et al. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS. 2011;25(11):657–64.

    Article  PubMed  Google Scholar 

  18. Aronson ID, et al. Mobile technology to increase HIV/HCV testing and overdose prevention/response among people who inject drugs. Front Public Health. 2017;5:217.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Prevention, C.F.D.C.A. Diagnoses of HIV infection among adults and adolescents in metropolitan statistical areas—United States and Puerto Rico, 2016. HIV Surveillance Supplemental Report 2018. https://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-supplemental-report-vol-23-2.pdf. Accessed 7 Feb 2019.

  20. Patrick ME, et al. HIV/AIDS risk behaviors and substance use by young adults in the United States. Prev Sci. 2012;13(5):532–8.

    Article  PubMed  PubMed Central  Google Scholar 

  21. WHO. The ASSIST project—alcohol, smoking and substance involvement screening test. 2011. http://www.who.int/substance_abuse/activities/assist/en/index.html. Accessed 19 Feb 2013.

  22. Aronson ID, et al. Feasibility of a computer-based intervention addressing barriers to HIV testing among young patients who decline tests at triage. J Health Commun. 2016;21(9):1039–45.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Aronson ID, Guarino H, Bennett A, Marsch LA, Gwadz M, Cleland C, Damschroder L, Bania TC. Staff perspectives on tablet-based interventions to increase HIV testing in a high volume, urban emergency department. Front Public Health. 2017;5:170.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Aronson ID, Rajan S, Cleland C, Marsch LA, Bania TC. Reported substance use and HIV testing among emergency department patients who complete a tablet-based intervention, in College of Problems on Drug Dependence 2018 Annual Meeting. 2018: San Diego, CA.

  25. Merchant RC, et al. Comparison of patient comprehension of rapid HIV pre-test fundamentals by information delivery format in an emergency department setting. BMC Public Health. 2007;7:238.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Merchant RC, et al. Video as an effective method to deliver pretest information for rapid human immunodeficiency testing. Acad Emerg Med. 2009;16(2):124–35.

    Article  PubMed  Google Scholar 

  27. Spielberg F, et al. Computer-facilitated rapid HIV testing in emergency care settings: provider and patient usability and acceptability. AIDS Educ Prev. 2011;23(3):206–21.

    Article  PubMed  Google Scholar 

  28. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall; 1986.

    Google Scholar 

  29. Bandura A. Social cognitive theory and exercise of control over HIV infection. In: DiClemente JPR, editor. Preventing AIDS theories and methods of behavioral interventions. New York: Plenum Publishing Corporation; 1994. p. 173–201.

    Google Scholar 

  30. Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.

    Article  CAS  PubMed  Google Scholar 

  31. Fisher JD, et al. Information-motivation-behavioral skills model-based HIV risk behavior change intervention for inner-city high school youth. Health Psychol. 2002;21(2):177–86.

    Article  PubMed  Google Scholar 

  32. O’Donnell L, et al. Keep it up: development of a community-based health screening and HIV prevention strategy for reaching young African American men. AIDS Educ Prev. 2009;21(4):299–313.

    Article  PubMed  Google Scholar 

  33. Jemmott JB 3rd, et al. HIV/STD risk reduction interventions for African American and Latino adolescent girls at an adolescent medicine clinic: a randomized controlled trial. Arch Pediatr Adolesc Med. 2005;159(5):440–9.

    Article  PubMed  Google Scholar 

  34. Hygiene, NYCDOHAM. Substance use and sexual risk among men who have sex with men injection drug users & high-risk heterosexuals: results from the national HIV behavioral surveillance study in New York City. 2010.

  35. Aronson ID, et al. Computer-based video to increase HIV testing among emergency department patients who decline. AIDS Behav. 2015;19(3):516–22.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Aronson ID, Plass JL, Bania TC. Optimizing educational video through comparative trials in clinical environments. Educ Technol Res Dev. 2012;60(3):469–82.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Jemmott JB 3rd, et al. Reducing HIV risk-associated sexual behavior among African American adolescents: testing the generality of intervention effects. Am J Community Psychol. 1999;27(2):161–87.

    Article  PubMed  Google Scholar 

  38. Gagné RM, Wager WW, Golas KC, Keller JM. Principles of instructional design. Belmont: Wadsworth/Thomson Learning; 2005.

    Google Scholar 

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Acknowledgements

This work was funded by the following Grants: NIH/NICHD R42HD088325, NIH/NIDA R34DA037129, NIH/NIDA P30DA029926, and NIH/NIDA P30DA011041.

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Authors and Affiliations

  1. College of Global Public Health, New York University, 726 Broadway, New York, NY, 10012, USA

    I. D. Aronson

  2. Department of Population Health, New York University School of Medicine, New York, NY, USA

    C. M. Cleland

  3. Columbia University, New York, NY, USA

    S. Rajan

  4. Dartmouth College, Hanover, NH, USA

    L. A. Marsch

  5. Mount Sinai St. Luke’s, New York, NY, USA

    T. C. Bania

Authors
  1. I. D. Aronson
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  2. C. M. Cleland
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  3. S. Rajan
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  4. L. A. Marsch
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  5. T. C. Bania
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Correspondence to I. D. Aronson.

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Aronson, I.D., Cleland, C.M., Rajan, S. et al. Computer-Based Substance Use Reporting and Acceptance of HIV Testing Among Emergency Department Patients. AIDS Behav 24, 475–483 (2020). https://doi.org/10.1007/s10461-019-02517-5

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