Brief Intervention to Increase Emergency Department Uptake of Combined Rapid Human Immunodeficiency Virus and Hepatitis C Screening Among a Drug Misusing Population

Abstract

Objectives 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, as compared to a self-administered risk assessment alone, increased uptake of combined screening for HIV and HCV, self-perception of HIV/HCV risk, and 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 three 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 (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% 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 c...

Elimination of hepatitis C virus infection among PWID: The beginning of a new era of interferon-free DAA therapy

“…Among 10,116 records identified, a total of 14 studies were included, of which 57% were randomised controlled trials. Interventions to enhance HCV testing included on-site testing with pre-test counselling and education (Cullen, et al, 2006;Hagedorn, et al, 2007;Lacey, Ellen, Devlin, Wright, & Mijch, 2007;Merchant, et al, 2014;Merchant, DeLong, Liu, & Baird, 2015;Rosenberg, et al, 2010;Roux, et al, 2016); and dried blood spot testing (Hickman, et al, 2008;Radley, et al, 2017). Interventions to enhance linkage to care included facilitated referral for HCV assessment and scheduling of specialist appointments for clients (Cullen, et al, 2006;Masson, et al, 2013;Tait, McIntyre, McLeod, Nathwani, & Dillon, 2010).…”

Aplicação do instrumento Alcohol, Smoking and Substance Involvement Screening Test (ASSIST): uma revisão integrativa

“…Regarding the level of evidence, the higher prevalence studies referred to those with level IV, that is, cross-sectional studies, which corresponded to 69.2% of the sample (2,(4)(5)(6)(7)(8)(9)(10)16,(18)(19)(20)(23)(24)(27)(28)(29)33) . Many professionals proceeded to the implementation of ASSIST and among them, we highlight different health professionals (53.8%) (5,7,10,(17)(18)(19)21,(23)(24)(25)(26)28,(31)(32) , followed by trained individuals named as interviewers (34.6%) (2,6,8,11,20,22,27,33) , and researchers (authors), which corresponded to 11,5% (9,16,25) . Regarding the database which the studies were obtained, 34.6% (5,7,11,(16)(17)…”

“…This IRL shows that 34.6% (5,7,11,(16)(17)(18)(19)(20)(21) of the studies came from the PubMed database, followed by CAPES Journals with 26.9% (2,(21)(22)(23)(24)(25)(26) , SciELO with 19.2% (19,24,(27)(28)(29) , Lilacs, with 15.4% (6,(8)(9)30) and Medline, with 3.8% (10) , 19 studies were duplicated in these databases. After selection, 26 studies were intended for analysis.…”

“…The application was conducted in heterogeneous groups with adult prevalence (73.1%) (2,(5)(6)(7)(8)(9)11,17,(20)(21)(22)(23)(24)(25)(26)(27)(30)(31)(32)(33) , followed by young students (15.4%) (16,17,19,28) , adolescents (7.7%) (10,29) and elderly (3.8%) (17) . Regarding the level of evidence, the higher prevalence studies referred to those with level IV, that is, cross-sectional studies, which corresponded to 69.2% of the sample (2,(4)(5)(6)(7)(8)(9)(10)16,(18)(19)(20)(23)(24)(27)(28)(29)33) .…”

A Randomized Controlled Trial of the Effects of a Brief Intervention to Increase Chlamydia and Gonorrhea Testing Uptake Among Young Adult Female Emergency Department Patients

“…The primary author has been trained in motivational interviewing techniques and has supervised the delivery of motivational interviews in other studies. 15,23 While the study recruitment was ongoing, the RAs met with the primary author weekly to discuss the intervention protocol, obtain clarification around use of motivational interviewing techniques, and review issues that arose from the delivery of the brief intervention.…”