title: Brief intervention to increase emergency department uptake of combined rapid human immunodeficiency virus and hepatitis C screening among a drug misusing population.
abstract: OBJECTIVE
  In this study, Increasing Viral Testing in the Emergency Department (InVITED), the authors investigated if a brief intervention about human immunodeficiency virus (HIV) and hepatitis C virus (HCV) risk-taking behaviors and drug use and misuse in addition to a self-administered risk assessment, compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and impacted beliefs and opinions on HIV/HCV screening.
  
  
  METHODS
  InVITED was a randomized, controlled trial conducted at two urban emergency departments (EDs) from February 2011 to March 2012. ED patients who self-reported drug use within the past 3 months were invited to enroll. Drug misuse severity and need for a brief or more intensive intervention was assessed using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were randomly assigned to one of two study arms: a self-administered HIV/HCV risk assessment alone (control arm) or the assessment plus a brief intervention about their drug misuse and screening for HIV/HCV (intervention arm). Beliefs on the value of combined HIV/HCV screening, self-perception of HIV/HCV risk, and opinions on HIV/HCV screening in the ED were measured in both study arms before the HIV/HCV risk assessment (pre), after the assessment in the control arm, and after the brief intervention in the intervention arm (post). Participants in both study arms were offered free combined rapid HIV/HCV screening. Uptake of screening was compared by study arm. Multivariable logistic regression models were used to evaluate factors related to uptake of screening.
  
  
  RESULTS
  Of the 395 participants in the study, the median age was 28 years (interquartile range [IQR] = 23 to 38 years), 44.8% were female, 82.3% had ever been tested for HIV, and 67.3% had ever been tested for HCV. Uptake of combined rapid HIV/HCV screening was nearly identical by study arm (64.5% vs. 65.2%; Δ = -0.7%; 95% confidence interval [CI] = -10.1% to 8.7%). Of the 256 screened, none had reactive HIV antibody tests, but seven (2.7%) had reactive HCV antibody tests. Multivariable logistic regression analysis results indicated that uptake of screening was not related to study arm assignment, total ASSIST drug scores, need for an intervention for drug misuse, or HIV/HCV sexual risk assessment scores. However, uptake of screening was greater among participants who indicated placing a higher value on combined rapid HIV/HCV screening for themselves and all ED patients and those with higher levels of perceived HIV/HCV risk. Uptake of combined rapid HIV/HCV screening was not related to changes in beliefs regarding the value of combined HIV/HCV screening or self-perceived HIV/HCV risk (post- vs. pre-risk assessment with or without a brief intervention). Opinions regarding the ED as a venue for combined rapid HIV/HCV screening were not related to uptake of screening.
  
  
  CONCLUSIONS
  Uptake of combined rapid HIV/HCV screening is high and considered valuable among drug using and misusing ED patients with little concern about the ED as a screening venue. The brief intervention investigated in this study does not appear to change beliefs regarding screening, self-perceived risk, or uptake of screening for HIV/HCV in this population. Initial beliefs regarding the value of screening and self-perceived risk for these infections predict uptake of screening.
authors.affiliation: The Department of Emergency Medicine, Alpert Medical School, Brown University, Providence, RI; The Department of Epidemiology, School of Public Health, Brown University, Providence, RI.
authors.forename: Roland C
authors.initials: RC
authors.lastname: Merchant
authors.forename: Janette R
authors.initials: JR
authors.lastname: Baird
authors.forename: Tao
authors.initials: T
authors.lastname: Liu
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Taylor
authors.forename: Brian T
authors.initials: BT
authors.lastname: Montague
authors.forename: Ted D
authors.initials: TD
authors.lastname: Nirenberg
mesh_terms: D000328:Adult; D055030:Drug Users / Q000523:psychology / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006526:Hepatitis C / Q000175:diagnosis*; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000523:psychology / Q000592:standards / Q000706:statistics & numerical data*; D012237:Rhode Island; D018570:Risk Assessment; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D055815:Young Adult