Will a tablet-based intervention encourage more reliable HIV risk reporting by young patients and facilitate testing?

Ian Aronson aronson.ian@gmail.com
Chuck Cleland cmc13@nyu.edu
David Perlman DPerlman@chpnet.org
Theodore Bania thbania@CHPNET.ORG

Abstract

Research in Progress

Will a tablet-based intervention encourage more reliable HIV risk reporting by young patients and facilitate testing? 

Background:

Many of those most at risk for HIV may not report risk factors (including substance use and sexual behavior) that greatly increase their likelihood of HIV infection. Some may not disclose risk or engage in any discussion of HIV because they fear consequences of stigma. Others may decline HIV testing because they, perhaps erroneously, believe they are not at risk.

Existing data show young people face increased HIV risk, and risk is further elevated for people who live or socialize in areas with high HIV prevalence. Effective prevention requires identifying high risk young people who do not have HIV infection, and taking steps to help them remain uninfected, such as lessening HIV risk behavior, or beginning a course of medication, such as pre-exposure prophylaxis.

Methods:

Research shows people are more comfortable reporting HIV risk to a computer compared to a person, and our research indicates people are more likely to accept an HIV test offered by computer than a test offered by a person: 20 percent accepted a test offered by a nurse, 42.2 percent accepted a test offered by computer (OR = 2.9). To increase risk reporting and test uptake by young people, we developed a tablet-based intervention to: screen young people for substance use and sexual risk; show a short video on the importance and ease of rapid HIV testing; offer an HIV test; and send follow-up text messages encouraging people who test negative to return for re-testing after 90 days, if they report increased risk and may have recently been exposed to HIV. Upon return, staff can discuss preventive options to remain uninfected.

Quantitative analysis will: 1) determine the feasibility and acceptability of tablet-based risk reporting; 2) estimate associations between reported risk behaviors and decisions to test for HIV post-intervention; 3) determine the feasibility of a text message follow-up protocol for high risk youth.

The intervention has been developed, piloted, and refined through formative evaluations, including an iterative process of revising the text message protocol and content in consultation with young patients.

In late February 2015 we are scheduled to begin a preliminary trial with 100 patients aged 18-24 in the Mount Sinai St. Luke’s Emergency Department, a high-volume clinical setting serving an area with one of the highest concentrations of HIV infections in New York City. 

Hypotheses:

H1. Use of tablet computers to provide detailed reports of substance use and sexual risk behaviors, including sex with multiple partners or sex while using drugs or alcohol, will be both feasible and acceptable to participants.

H2. Reporting of HIV risks will increase the odds of accepting an HIV test at the end of the intervention.

H3. The tablet-based intervention will assist providers in identifying high-risk, HIV negative youth, and facilitate follow-up contact via text message.

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