Effectiveness of Increasing Emergency Department Patients’ Self-perceived Risk for Being Human Immunodeficiency Virus (HIV) Infected Through Audio Computer Self-interview–based Feedback About Reported HIV Risk Behaviors

Authors

  • Roland C. Merchant MD, MPH, ScD,

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author
  • Melissa A. Clark PhD,

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author
  • Thomas J. Langan IV,

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author
  • George R. Seage III MPH, ScD,

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author
  • Kenneth H. Mayer MD,

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author
  • Victor G. DeGruttola ScD

    1. From the Department of Emergency Medicine (RCM, TJL), the Department of Community Health (RCM, MAC, KHM), and the Department of Medicine, Division of Infectious Diseases (KHM), Alpert Medical School of Brown University, Providence, RI; and the Department of Epidemiology (GRS) and the Department of Biostatistics (VGD), Harvard School of Public Health, Boston, MA.
    Search for more papers by this author

  • Dr. Merchant and this study were supported by a career development grant from the National Institute for Allergy and Infectious Diseases (K23 A1060363). Dr. Mayer was supported by the Center for AIDS Research at Lifespan/Tufts/Brown (P30 AI42853).

Address for correspondence and reprints: Roland C. Merchant, MD, MPH, ScD; e-mail: rmerchant@lifespan.org.

Abstract

Objectives:  Prior research has demonstrated that emergency department (ED) patient acceptance of human immunodeficiency virus (HIV) screening is partially dependent on patients’ self-perceived risk of infection. The primary objective of this study was to determine the effectiveness of audio computer-assisted self-interview (ACASI)-based feedback. The intervention aimed to increase patient’s self-perceived risk of being HIV infected by providing immediate feedback on their risk behaviors.

Methods:  This 1-year, randomized, controlled trial at a U.S. ED enrolled a random sample of 18- to 64-year-old subcritically ill or injured adult patients who were not known to be HIV infected. All participants completed an anonymous, ACASI-based questionnaire about their HIV risk behaviors related to injection drug use and sex, as well as their self-perceived risk for being HIV infected. Participants were randomly assigned to one of two study groups: an intervention group in which participants received immediate ACASI-based feedback in response to each of their reported risk behaviors or a no-intervention group without feedback. Participants were asked to indicate their level of HIV risk on a five-point scale before and after they answered the questions. Change in level of self-perceived HIV risk was calculated and compared by study group using Pearson’s chi-square test. An HIV risk behavior score that summarized reported HIV risk behavior was devised. Because HIV risk behaviors differ by sex, scores were calculated separately for each sex. Linear regression models that adjusted for study group and same subject covariance were employed to determine if higher HIV risk behavior scores were associated with an increase in self-perceived HIV risk.

Results:  Of the 566 trial participants, the median age was 29 years (interquartile range [IQR] = 22–43 years), 62.2% were females, and 66.9% had been tested previously for HIV. After answering the reported HIV risk behavior questions, 12.6% of participants had an increase, 79.9% had no change, and 7.5% had a decrease in self-perceived HIV risk. Of the 46.6% of participants who initially indicated that they were not at risk for HIV, 11.4% had an increase in self-perceived HIV risk after answering the reported HIV risk behavior questions. Change in self-perceived HIV risk did not differ by study group (p = 0.77). There were no differences in reported HIV risk scores between the intervention and no-intervention groups for females (p = 0.78) or males (p = 0.86). In the linear regression models, a greater increase in self-perceived HIV risk was associated with higher reported HIV risk behavior scores for females (β = 0.59, 95% confidence interval [CI] = 0.15, 1.04) but not for males (β = 1.00, 95% CI = −0.13 to 2.14).

Conclusions:  Some ED patients can be moved, although modestly, to recognize their risk for being HIV infected by asking about their HIV risk behaviors. However, ACASI-based feedback messages about HIV risk behaviors do not increase subjects’ self-perceived HIV risk. Female ED patients appear to increase their self-perceived HIV risk more than males when queried about their HIV risk behaviors.

Ancillary