Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
Department of Communication, University of Kentucky, Lexington, Kentucky, USA.
BMJ Open. 2024 Aug 12;14(8):e089265. doi: 10.1136/bmjopen-2024-089265.
Previous studies have shown that substantial percentages of emergency department (ED) patients in the USA recommended for HIV or hepatitis C (HCV) decline testing. Evidence-based and cost-effective interventions to improve HIV/HCV testing uptake are needed, particularly for people who inject drugs (PWIDs) (currently or formerly), who comprise a group at higher risk for these infections. We developed a brief persuasive health communication intervention (PHCI) designed to convince ED patients who had declined HIV/HCV testing to agree to be tested. In this investigation, we will determine if the PHCI is more efficacious in convincing ED patients to be tested for HIV/HCV when delivered by a video or in person, and whether efficacy is similar among individuals who currently, previously or never injected drugs.
We will conduct a multisite, randomised controlled trial comparing PHCIs delivered by video versus in person by a health educator to determine which delivery method convinces more ED patients who had declined HIV/HCV testing instead to be tested. We will stratify randomisation by PWID status (current, former or never/non-PWID) to permit analyses comparing the PHCI delivery method by injection-drug use history. We will also perform a cost-effectiveness analysis of the interventions compared with current practice, examining the incremental cost-effectiveness ratio between the two interventions for the ED population overall and within individual strata of PWID. As an exploratory analysis, we will assess if a PHCI video with captions confers increased or decreased acceptance of HIV/HCV testing, as compared with a PHCI video without captions.
The study protocol has been approved by the institutional review board of the Icahn School of Medicine. The results will be disseminated at international conferences and in peer-reviewed publications.
NCT05968573.
先前的研究表明，美国相当大比例的急诊科 (ED) 患者被建议进行 HIV 或丙型肝炎 (HCV) 检测，但他们拒绝了检测。需要采取基于证据且具有成本效益的干预措施来提高 HIV/HCV 检测率，特别是对于目前或曾经使用过毒品的人群（即药物滥用者，PWIDs），他们感染这些疾病的风险更高。我们开发了一种简短的有说服力的健康沟通干预 (PHCI)，旨在说服拒绝 HIV/HCV 检测的 ED 患者同意接受检测。在这项研究中，我们将确定 PHCI 通过视频或面对面的方式传达时，是否更能说服 ED 患者接受 HIV/HCV 检测，以及对于当前、以前或从未使用过毒品的个体，其效果是否相似。
我们将进行一项多站点、随机对照试验，比较由健康教育家通过视频或面对面两种方式传递 PHCI，以确定哪种传递方式更能说服更多拒绝 HIV/HCV 检测的 ED 患者接受检测。我们将根据 PWID 状态（当前、以前或从未/非 PWID）进行分层随机化，以允许分析比较根据注射毒品使用史的 PHCI 传递方法。我们还将对干预措施与当前实践进行成本效益分析，比较两种干预措施对整个急诊科人群和不同 PWID 人群的增量成本效益比。作为一项探索性分析，我们将评估与无字幕的 PHCI 视频相比，带字幕的 PHCI 视频是否会增加或降低对 HIV/HCV 检测的接受度。
该研究方案已获得 Icahn 医学院机构审查委员会的批准。研究结果将在国际会议和同行评议的出版物上发表。
NCT05968573。
