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A randomized controlled trial of computer counseling to administer rapid HIV test consent and counseling in a public emergency department: final results
Presented by Ann Kurth, United States.
Kurth A.1, Spielberg F.2, Severynen A.1, Holt D.3
1University of Washington, School of Nursing: Biobehavioral Nursing & Health Systems, Seattle, United States, 2Formerly with University of Washington, Center for AIDS & STDs, Seattle, United States, 3University of Washington, Harborview Medical Center, Seattle, United States
Objectives: Evaluate whether a computer counseling tool (CARE: Computer Assessment and Risk reduction Education) facilitates rapid HIV testing in an emergency department (ED).
Methods: Adult participants (n=517) presenting to a large urban ED and not known to be HIV+ were randomized to CARE and OraSure rapid oral fluid test before clinic visit (n=258) or to chart review control (n=259). CARE provides risk assessment, tailored feedback and videos, test consent, and risk reduction planning on audio-narrated tablet computers. Both arms did in-person exit surveys. We assessed HIV test uptake, and costs.
Results: Intervention participants were 56% non-white, 58% male, 61% chemical dependency-screen positive; median age 37. 54% reported unprotected vaginal/anal sex in last two months, among whom 28% (64/132) had sex with a non-concordant partner (HIV status positive or unknown). Mean CARE session was 27.3 minutes (SD 12.3, mode 19). 97% (251/258) in CARE arm took and got rapid HIV test results: 1 confirmed positive was referred to treatment; 2 tested false positive, yielding HIV seroprevalence of 0.4% (95% CI 0.01-2.2%), specificity of 99.2% (95% CI 97.15-99.90%). Among controls no HIV tests were done; 2 HIV test referrals were noted. Sexual risk was indicated by 58.6% of CARE arm and noted by clinicians in 0.8% of control arm charts. Compared to staff counseling, 83% found CARE more “private”, 77% more “convenient”, 76% more “comfortable”, 72% “safer”, and more “helpful”. 55% of all participants said they would choose computer over face-to-face counseling for future HIV testing. Staff cost for conducting computer-assisted rapid HIV testing with 258 participants was $5335.44 (mean staff salary/benefits US$22/hour, mean 56 minutes for study consent, specimen collection/processing, CARE session, verbal test results and follow-up).
Conclusions: Computerized counseling may substantially increase delivery of HIV testing with patients in ED settings, facilitating implementation of national recommendations to expand HIV testing.
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