Results from a multimedia testing and counseling program in an urban emergency department
© Calderon et al; licensee BioMed Central Ltd. 2010
Published: 11 May 2010
This study evaluates a novel approach to counseling and testing in a high-volume inner-city ED which utilizes an HIV counselor and a multimedia tool for conveying video HIV information and electronically collecting risk factor data. We evaluated this program to assess the demographic and risk factor characteristics of all patients tested, patient-reported satisfaction with the program and outcomes for positive patients.
This prospective cross-sectional evaluation was conducted for 2 years. A convenience sample of medically stable patients presenting to an inner-city municipal hospital ED were recruited by 3 to 8 full-time equivalent HIV counselors. Previously developed and validated videos for HIV pre- and post-test counseling were used. Demographic characteristics, risk factors, and satisfaction information were collected using patient self-reporting on the touch screen computer. Data downloaded automatically into a secure database. Chart reviews were conducted by the HIV-positive patients' medical provider to assess outcomes. Data were analyzed using SPSS software.
During the federal grant period, 28,995 patients were tested for HIV. Demographic characteristics of the participants were: 41.9% male, mean age 36.0 ± 14.2 years, 54.7% Hispanic, and 32.2% African-American. Risk factors were: 6.4% MSM, 31.0% had multiple sex partners in the past 3 months, 49.8% reported condom use as "never," 1.5% used injection drugs. Patient satisfaction was high: 88.8% reported learning a moderate-to-large amount of new information about HIV and 78.6% preferred the format which included both videos and an HIV counselor. There were 101 newly diagnosed or confirmed HIV positive patients and 86% were linked to outpatient HIV care; mean days to first medical visit was 7. Positive patient outcomes were as follows: 85% of eligible patients began HAART, median days to HAART treatment was 35, 62% of patients on HAART had viral load less than 400 copies/mL.
A rapid HIV program using a multimedia tool and a counselor in a busy inner-city hospital ED can effectively test a large number of patients, provide consistent prevention messages to patients who report multiple HIV risk factors and link a large percentage HIV-positive patients to existing health care systems.
This article is published under license to BioMed Central Ltd.