Mobile Augmented Screening Tool to Increase Adolescent HIV Testing and Linkage to Care

Aronson, Ian

Abstract

Adolescents face combined problems of increased HIV risk, infrequent testing, inconsistent linkage to care, and a lack of prevention related knowledge. We propose to address this by developing a Mobile Augmented Screening (MAS) tool that will increase youth HIV testing through the use of a tablet-based intervention in clinica settings, and then use text messages to facilitate linkage to care for those who test positive, and deliver ongoing prevention education via text message to those who test negative. Many adolescents and young adults at greatest risk for HIV are unlikely to have access to primary care, and therefore have limited access to HIV testing and prevention education. When young people are offered testing, many decline because they believe (perhaps incorrectly) they are not at risk or because they fear being stigmatized. Our proposed MAS will enable care providers to privately and discretely offer routine HIV testing and counseling, including prevention education, to high need, diverse adolescent populations at a low cost. Further, because the Affordable Care Act now requires public and private insurers to cover routine HIV testing, healthcare providers who use our proposed MAS to test an increased number of youth can potentially generate significant additional revenue through increased insurance reimbursements. The MAS will consist of 3 components. A tablet-based intervention including a very brief video (<2 minutes) designed to increase adolescent HIV testing, automated text-messages to facilitate linkage to care for those who test positive, and text-based education for those who test negative or decline testing. All 3 components will be linked by an easy to use administrative interface. Our team has created multiple NIH-funded interventions to increase HIV testing among patients in high volume, urban emergency departments (EDs). Patients, including those who initially declined testing, cited the privacy and clarity of our technology-based approach as reasons they ultimately agreed to test for HIV. In a recent pilot trial, we recruited 100 ED patients aged 18 - 24 who declined testing at triage. Participants completed a brief tablet-based video intervention, and after watching a short video, 30 accepted an HIV test offered by computer. Of those who accepted tests, 21 agreed to receive text messages about HIV testing and prevention for 12 weeks. Two thirds responded to texts at week 6, more than half responded at week 8. Digital Health Empowerment is a minority and woman owned SBC. Principals So-Young Oh and Ian David Aronson, Ph.D. have more than 10 years' experience developing technology products together, including video- based health interventions and other digital content, for non-profit, commercial, and university clients. We plan to build upon this expertise to: interview ED patients aged 13 - 24 (n=20) regarding how video and text messages can be used most effectively; develop a video and text messages informed by interview data; conduct a mixed-methods evaluation of the resulting video and texts with ED patients (n=24) aged 18 - 24.

Public Health Relevance

Because adolescents and young adults face markedly increased HIV risk yet frequently do not test, we propose to develop a Mobile Augmented Screening (MAS) tool designed to increase HIV testing, and to facilitate linkage to care and ongoing prevention education. This tool will help clinicians address undiagnosed youth HIV, and enable young patients to receive much needed treatment and avoid unknowingly transmitting infection. Our product is designed to help existing program staff reach an increased number of clients; and to improve public health by encouraging reluctant young patients to accept important HIV testing and care they may otherwise decline.