Project Control. An innovative multimedia HIV testing system adapted for teens

Transcription

1 Project Control An innovative multimedia HIV testing system adapted for teens Yvette Calderon, M.D., M.S. Professor of Clinical Emergency Medicine Albert Einstein College of Medicine Jacobi Medical Center, New York, USA

2 Significance At the end of 2006, an estimated 1,106,400 persons in the United States were living with HIV infection. (Centers for Disease Control MMWR ) 21% are undiagnosed and unaware of their HIV infection (Centers for Disease Control MMWR ) CDC estimated that approximately 56,300 people were newly infected with HIV in 2006 (Centers for Disease Control MMWR )

3 Significance Adolescents are disproportionately affected by HIV. Approximately half of new HIV infections in the U.S. occur among individuals years. Teenagers account for 20,000 new infections annually, of which 75% are in racial or ethnic minority groups. Teens are particularly vulnerable to HIV risk behaviors. Half of teens initiate sexual intercourse prior to age 16 when they are biologically and emotionally less mature. Many use alcohol and drugs in combination with sexual activity, which is a barrier to condom use. 2/3 of teenagers do not use condoms on a consistent basis

4 Objective To compare the effectiveness of a theorybased HIV educational video tool with inperson HIV counseling in promoting safer sex behaviors among adolescent patients of an urban Emergency Department (ED).

5 Project Control Phase 1: Qualitative Research 100 individual interviews with Bronx teens Video Production Phase 2: RCT- HIV Pre-test Video Video increased HIV knowledge and participation in HIV testing better than in-person counseling. Phase 3: RCT- HIV Post-test Video Behavioral Intervention Video Series

6 Intervention

7 Intervention Stages of Change: provides a framework to tailor information to participant s current stage of change (SOC). Theory of Reasoned Action: drives the content which will include self- efficacy expectancies, outcome expectancies and condom use intention, relevant to the stages of change of each individual teen which was identified through the interactive computer program.

8 Methods Subjects Inclusion Criteria All patients sexually active Patients presenting to the Pediatric and Adult ED between the hours of 8am-4pm, Monday-Friday. Exclusion criteria Clinical instability HIV testing within 6 months Inability to comprehend the consent process

9 Methods Study Design -Prospective randomized study -Conducted at the Pediatric and Adult ED of Jacobi Medical Center -Patients were recruited by research assistants who obtained informed consent for the study

10 Methodology Post-Test Video RCT Study Design Participant Flow Diagram Pre-intervention measures Consent for HIV Test Teen Pre-test Video Randomization Video Intervention Group PC/Contemplation Neg. Consequences Prep./Action/Maintenance Positive Consequences Counselor Group (Control) Post-intervention measures Satisfaction Questionnaire HIV Test Results Delivered (if applicable)

11 Methodology Project Control Post-HIV Test Video Intervention Series Video 1 Teens discussing whether or not to use condoms Video 2A SOC: Pre-contemplation, contemplation Negative Consequences of Not Using Condoms Video 2B SOC: Preparation, Action, Maintenance Positive Consequences of Using Condoms Video 3 Condom Use Demonstration

12 Measures of Risk Reduction Behavior Participants completed pre- and post-intervention measures on: Condom Use Intention: one s resolve to perform a behavior Condom Use Self-Efficacy: attitude of one s ability to perform a behavior Condom Use Outcome Expectancies: beliefs on the likely consequences for a behavior

13 Results Population Characteristics Video (n=102) Counselor (n=101) 2 p-value Age < 18y 20.6% 25.7% Female gender 60.8% 55.4% Race -American Indian -Asian -Black -White -Other 1.0% 2.9% 34.3% 8.8% 52.9% 1.0% 1.0% 42.6% 3.0% 52.5% Hispanic 59.8% 57.4% Previous HIV test 65.7% 68.3%

14 Results Participants HIV Risk Factors Video (n=102) Counselor (n=101) 2 p-value Vaginal Sex in past year 97.1% 96.0% Anal Sex in past year 26.5% 21.8% Oral Sex in past year 72.5% 62.4% Mean number of male sex partners Mean number of female sex partners

15 Results Effects of Video and Counselor on Teenagers Intentions for Condom Use Condom Use measure Condom Use Intention Score Video Mean improvement Counselor Mean improvement Mean difference (video vs. counselor) p-value 95% CI (0.24, 2.30) Condom Self-Efficacy Male Condom Outcome Expectancy Female Condom Outcome Expectancy (0.03, 0.50) (0.02, 0.28) (-0.01, 0.40)

16 Conclusions A theory-based, youth-friendly video can be a valid means to provide post-test HIV education and prevention messages within an urban ED. Longitudinal studies are needed to determine the length of time a video educational program can affect adolescent risk reduction behavior.

17 Acknowledgements K23 NICHD Dr. Laurie Bauman Dr. Jason Leider Dr. Ethan Cowan Dr. Cheng-Shiun Leu Staff: Sheba Mathew Jillian Nickerson Chris Brusalis