Increasing HIV Testing in Urban Emergency Departments Via Mobile Technology

Because people with undiagnosed HIV will not receive treatment and may unknowingly infect
others, the investigators propose a mobile computer-based video intervention to increase HIV
test rates in high volume urban hospital emergency departments (EDs). EDs offer important
points of contact for many of those at greatest risk for HIV. Unfortunately, when ED
patients are offered routine HIV testing, most decline. Our proposed intervention builds
upon initial findings from a trial our research team conducted with patients who declined
HIV testing. The intervention, grounded in the Information-Motivation and Behavioral Skills
model (IMB), showed an onscreen physician explaining the importance of HIV testing (to build
knowledge and motivation) and modeling a rapid HIV test (to increase motivation and
behavioral skill). This brief intervention had a potent effect: a third accepted HIV testing
post-intervention. While this preliminary study is highly encouraging, it revealed a number
of other critical research questions. First, it remains unclear what intervention component
most strongly contributed to patients' decisions to test: the video content or the offer of
an HIV test by a computer rather than a person. Second, consistent with the literature,
participants indicated a community member disclosing positive HIV status onscreen would
increase the proportion of patients who test. Third, results suggest there is individual
variation in the extent to which behavior is more strongly influenced by onscreen community
members or experts (e.g. physicians). Therefore, the goal of the present study, guided by
the IMB model, is to determine how the investigators can refine mobile computer-based
interventions to maximize HIV testing rates among patients who initially decline to test in
the ED. At the end of the computerized intervention, onscreen text will ask patients if they
would agree to an HIV test. Those who agree will be tested by ED staff. The study's endpoint
will be post-intervention HIV test rates. The investigators' study will inform scalable
interventions for underserved populations nationwide.