Testing a Persuasive Health Communication Intervention (PHCI) for Emergency Department Patients Who Declined Rapid HIV/HCV Screening: a Randomised Controlled Trial Study Protocol

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Aug 12

PMID 39134444

Authors

Roland C Merchant

Nancy Harrington

Melissa A Clark

Tao Liu

Jake Morgan

Ethan Cowan

Rachel Solnick

Benjamin Wyler

Affiliations

Soon will be listed here.

Abstract

Introduction: 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.

Methods And Analysis: 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.

Ethics And Dissemination: 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.

Trial Registration Number: NCT05968573.

References

Schulz K, Altman D, Moher D . CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMJ. 2010; 340:c332. PMC: 2844940. DOI: 10.1136/bmj.c332. View

Wu G, Zhou A, Kwon S . Integrating hepatitis C virus screening of baby boomers at a community hospital emergency department. J Viral Hepat. 2022; 29(4):263-270. DOI: 10.1111/jvh.13654. View

Merchant R, Baird J, Liu T, Taylor L, Montague B, Nirenberg T . Brief intervention to increase emergency department uptake of combined rapid human immunodeficiency virus and hepatitis C screening among a drug misusing population. Acad Emerg Med. 2014; 21(7):752-67. PMC: 4135533. DOI: 10.1111/acem.12419. View

Williams J, Vickerman P, Douthwaite S, Nebbia G, Hunter L, Wong T . An Economic Evaluation of the Cost-Effectiveness of Opt-Out Hepatitis B and Hepatitis C Testing in an Emergency Department Setting in the United Kingdom. Value Health. 2020; 23(8):1003-1011. DOI: 10.1016/j.jval.2020.03.014. View

Mendlowitz A, Naimark D, Wong W, Capraru C, Feld J, Isaranuwatchai W . The emergency department as a setting-specific opportunity for population-based hepatitis C screening: An economic evaluation. Liver Int. 2020; 40(6):1282-1291. DOI: 10.1111/liv.14458. View

Merchant R, Clark M, Langan 4th T, Mayer K, Seage 3rd G, DeGruttola V . Can computer-based feedback improve emergency department patient uptake of rapid HIV screening?. Ann Emerg Med. 2011; 58(1 Suppl 1):S114-9.e1-2. PMC: 3205940. DOI: 10.1016/j.annemergmed.2011.03.035. View

Schillie S, Wester C, Osborne M, Wesolowski L, Ryerson A . CDC Recommendations for Hepatitis C Screening Among Adults - United States, 2020. MMWR Recomm Rep. 2020; 69(2):1-17. PMC: 7147910. DOI: 10.15585/mmwr.rr6902a1. View

Park J, Wong J, Cohen H . Hepatitis C virus screening of high-risk patients in a community hospital emergency department: Retrospective review of patient characteristics and future implications. PLoS One. 2021; 16(6):e0252976. PMC: 8191914. DOI: 10.1371/journal.pone.0252976. View

Hsu H, Walensky R . Cost-effectiveness analysis and HIV screening: the emergency medicine perspective. Ann Emerg Med. 2011; 58(1 Suppl 1):S145-50. PMC: 3510483. DOI: 10.1016/j.annemergmed.2011.03.039. View

10.

Basu A, Rathouz P . Estimating marginal and incremental effects on health outcomes using flexible link and variance function models. Biostatistics. 2004; 6(1):93-109. DOI: 10.1093/biostatistics/kxh020. View

11.

Cowan E, Brandspiegel S, Araki B, OBrien-Lambert C, Merchant R, Buckler D . Relationship of hepatitis C risk to hepatitis C test acceptance among adult patients participating in an ED hepatitis C screening programme. Emerg Med J. 2023; 40(5):341-346. PMC: 10176391. DOI: 10.1136/emermed-2022-212726. View

12.

Czarnogorski M, Brown J, Lee V, Oben J, Kuo I, Stern R . The Prevalence of Undiagnosed HIV Infection in Those Who Decline HIV Screening in an Urban Emergency Department. AIDS Res Treat. 2011; 2011:879065. PMC: 3124124. DOI: 10.1155/2011/879065. View

13.

. Recommendations for prevention and control of hepatitis C virus (HCV) infection and HCV-related chronic disease. Centers for Disease Control and Prevention. MMWR Recomm Rep. 1998; 47(RR-19):1-39. View

14.

Galbraith J, Franco R, Donnelly J, Rodgers J, Morgan J, Viles A . Unrecognized chronic hepatitis C virus infection among baby boomers in the emergency department. Hepatology. 2014; 61(3):776-82. DOI: 10.1002/hep.27410. View

15.

Murphy S, Jeng P, Poole S, Jalali A, Vocci F, Gordon M . Health and economic outcomes of treatment with extended-release naltrexone among pre-release prisoners with opioid use disorder (HOPPER): protocol for an evaluation of two randomized effectiveness trials. Addict Sci Clin Pract. 2020; 15(1):15. PMC: 7178627. DOI: 10.1186/s13722-020-00188-5. View

16.

Lyons M, Lindsell C, Ruffner A, Wayne D, Hart K, Sperling M . Randomized comparison of universal and targeted HIV screening in the emergency department. J Acquir Immune Defic Syndr. 2013; 64(3):315-23. PMC: 4241750. DOI: 10.1097/QAI.0b013e3182a21611. View

17.

Branson B, Handsfield H, Lampe M, Janssen R, Taylor A, Lyss S . Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recomm Rep. 2006; 55(RR-14):1-17. View

18.

Smith B, Morgan R, Beckett G, Falck-Ytter Y, Holtzman D, Teo C . Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recomm Rep. 2012; 61(RR-4):1-32. View

19.

Mwachofi A, Fadul N, Dortche C, Collins C . Cost-effectiveness of HIV screening in emergency departments: a systematic review. AIDS Care. 2020; 33(10):1243-1254. DOI: 10.1080/09540121.2020.1817299. View

20.

Felsen U, Torian L, Futterman D, Stafford S, Xia Q, Allan D . An expanded HIV screening strategy in the Emergency Department fails to identify most patients with undiagnosed infection: insights from a blinded serosurvey. AIDS Care. 2019; 32(2):202-208. PMC: 6884659. DOI: 10.1080/09540121.2019.1619663. View