HIV Screening Take-up: Evaluating Incentives and Opt-out Strategies
13 mei 2015 bijgewerkt door: University of California, San Francisco
Over twenty percent of HIV-positive persons in the United States are unaware of their infection, leading the Institute of Medicine to recently urge further work to compare the effectiveness of HIV screening strategies.
This study will use a randomized trial to compare several variants of emergency-room-based HIV-testing policies in order to determine how HIV test acceptance rates can be increased.
The testing policies will be designed using principles from behavioral economics, varying the choice architecture and offering small monetary incentives.
This will be the first study to measure differences in take-up rates across a variety of promising but largely untested approaches within a unified randomized trial.
Three defaults will be tested: traditional opt-in (test only those patients who request testing), opt-out (routinely testing unless patients decline), and active-choice testing (patients are required to state whether they want to be tested).
The study will also be the first to test the effect of small monetary incentives ($1, $5, $10) on test take-up.
An additional novel study contribution will be to test the hypothesis that compliance with large requests (accept an HIV test) increases after making a small request or pre-commitment - this "foot in the door" technique has not been previously studied in this setting.
The factorial design will permit a direct comparison of all interventions, as well as interactions.
The study will contribute a nuanced empirical understanding of how testing protocols from behavioral economics theory affect the effectiveness and efficiency of screening programs in an actual scaled- up setting (San Francisco General Hospital).
This will assist in implementing and assessing recent CDC guidelines on HIV screening, while also more generally advancing scientific knowledge related to applying behavioral economics in comparative effectiveness research.
Studie Overzicht
Toestand
Voltooid
Conditie
Interventie / Behandeling
Studietype
Ingrijpend
Inschrijving (Werkelijk)
8572
Fase
- Niet toepasbaar
Contacten en locaties
In dit gedeelte vindt u de contactgegevens van degenen die het onderzoek uitvoeren en informatie over waar dit onderzoek wordt uitgevoerd.
Studie Locaties
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California
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San Francisco, California, Verenigde Staten, 94122
- San Francisco General Hospital
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Deelname Criteria
Onderzoekers zoeken naar mensen die aan een bepaalde beschrijving voldoen, de zogenaamde geschiktheidscriteria. Enkele voorbeelden van deze criteria zijn iemands algemene gezondheidstoestand of eerdere behandelingen.
Geschiktheidscriteria
Leeftijden die in aanmerking komen voor studie
13 jaar tot 64 jaar (Kind, Volwassen)
Accepteert gezonde vrijwilligers
Ja
Geslachten die in aanmerking komen voor studie
Allemaal
Beschrijving
Inclusion Criteria:
- Patients aged 13 - 64 years who are awake, alert, not intoxicated, and understand the premise of the test will be offered the test and questionnaire according to their treatment group.
Exclusion Criteria:
- Patients who have altered levels of consciousness, are critically ill (e.g., serious trauma), are known to have preexisting HIV diagnosis, or who have been tested for HIV in the past 3 months will be excluded from the study.
- Pregnant patients will be excluded due to alternative guidelines for incorporating opt-out testing during prenatal care.
- Any patients who are in police custody will also be excluded due to their lack of control over study participation decisions and ethical concerns over possible coercion.
Studie plan
Dit gedeelte bevat details van het studieplan, inclusief hoe de studie is opgezet en wat de studie meet.
Hoe is de studie opgezet?
Ontwerpdetails
- Primair doel: Screening
- Toewijzing: Gerandomiseerd
- Interventioneel model: Opdracht voor een enkele groep
- Masker: Geen (open label)
Wapens en interventies
Deelnemersgroep / Arm |
Interventie / Behandeling |
|---|---|
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Experimenteel: Opt-In
Opt-in refers to a default of no test - patients must ask for the test in order to receive it.
Patients are informed of the availability of rapid testing.
They are tested only if they request the test.
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HIV Test will be offered as opt-in, opt-out, or active choice.
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Experimenteel: Opt-Out
Opt-out has a default to test - patients are informed that they will receive a rapid HIV screening test unless they decline it.
Patients will be tested unless they decline.
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HIV Test will be offered as opt-in, opt-out, or active choice.
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Experimenteel: Active Choice
In the active choice treatment, there is no default; patients must actively accept or actively decline the test.
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HIV Test will be offered as opt-in, opt-out, or active choice.
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Experimenteel: $1 Incentive
When offering the HIV test, study staff will inform subjects that the ED is offering cash incentives to promote HIV testing (and that the test is also free), and will inform them of that day's value.
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$1, $5, or $10 incentive
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Experimenteel: $5 Incentive
When offering the HIV test, study staff will inform subjects that the ED is offering cash incentives to promote HIV testing (and that the test is also free), and will inform them of that day's value.
|
$1, $5, or $10 incentive
|
|
Experimenteel: $10 Incentive
When offering the HIV test, study staff will inform subjects that the ED is offering cash incentives to promote HIV testing (and that the test is also free), and will inform them of that day's value.
|
$1, $5, or $10 incentive
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Experimenteel: Early Questionnaire
At a time that does not interfere with patients' medical care, patients will be approached by a member of the research team to consent to and complete a short (3 minutes) questionnaire.
The questionnaire is designed to elicit two things: subjective risk of infection (e.g., What are the chances you have HIV? [Not possible, Unlikely, Possible, Likely, Certain]) and objective risk of infection (e.g., In the past year, have you given anyone drugs or money for sex?).
The questionnaire will be administered as one of two timing treatments - a) at the beginning of care, before the patient is offered an HIV test (Early questionnaire) or b) after the patient has been offered an HIV test (Late questionnaire).
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Timing of the questionnaire--either before or after testing is offered.
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Experimenteel: Late Questionnaire
At a time that does not interfere with patients' medical care, patients will be approached by a member of the research team to consent to and complete a short (3 minutes) questionnaire.
The questionnaire is designed to elicit two things: subjective risk of infection (e.g., What are the chances you have HIV? [Not possible, Unlikely, Possible, Likely, Certain]) and objective risk of infection (e.g., In the past year, have you given anyone drugs or money for sex?).
The questionnaire will be administered as one of two timing treatments - a) at the beginning of care, before the patient is offered an HIV test (Early questionnaire) or b) after the patient has been offered an HIV test (Late questionnaire).
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Timing of the questionnaire--either before or after testing is offered.
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Experimenteel: FITD Questionnaire
There will be two versions of the early questionnaire: one standard Early questionnaire, and one with an additional question: "If you were offered an HIV test as part of your routine health care at no cost, would you get tested?"
The two questionnaires will be otherwise identical.
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Timing of the questionnaire--either before or after testing is offered.
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Experimenteel: Free
When offering the HIV test, study staff will inform subjects that the ED is offering HIV testing (and that the test is also free); no monetary incentive will be offered.
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$1, $5, or $10 incentive
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Wat meet het onderzoek?
Primaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
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Proportion of patients offered an HIV test who accept
Tijdsspanne: Monthly
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Monthly
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Secundaire uitkomstmaten
Uitkomstmaat |
Tijdsspanne |
|---|---|
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Proportion testing HIV positive of those tested
Tijdsspanne: Monthly
|
Monthly
|
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Proportion testing HIV positive among those offered a test
Tijdsspanne: Monthly
|
Monthly
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Medewerkers en onderzoekers
Hier vindt u mensen en organisaties die betrokken zijn bij dit onderzoek.
Onderzoekers
- Hoofdonderzoeker: William H Dow, PhD, University of California, Berkeley
- Hoofdonderzoeker: Beth Kaplan, MD, University of California, San Francisco
Publicaties en nuttige links
De persoon die verantwoordelijk is voor het invoeren van informatie over het onderzoek stelt deze publicaties vrijwillig ter beschikking. Dit kan gaan over alles wat met het onderzoek te maken heeft.
Studie record data
Deze datums volgen de voortgang van het onderzoeksdossier en de samenvatting van de ingediende resultaten bij ClinicalTrials.gov. Studieverslagen en gerapporteerde resultaten worden beoordeeld door de National Library of Medicine (NLM) om er zeker van te zijn dat ze voldoen aan specifieke kwaliteitscontrolenormen voordat ze op de openbare website worden geplaatst.
Bestudeer belangrijke data
Studie start
1 mei 2011
Primaire voltooiing (Werkelijk)
1 december 2013
Studie voltooiing (Werkelijk)
1 december 2013
Studieregistratiedata
Eerst ingediend
18 juni 2011
Eerst ingediend dat voldeed aan de QC-criteria
20 juni 2011
Eerst geplaatst (Schatting)
21 juni 2011
Updates van studierecords
Laatste update geplaatst (Schatting)
14 mei 2015
Laatste update ingediend die voldeed aan QC-criteria
13 mei 2015
Laatst geverifieerd
1 mei 2015
Meer informatie
Termen gerelateerd aan deze studie
Andere studie-ID-nummers
- 10562983
- 1RC4AG039078-01 (Subsidie/contract van de Amerikaanse NIH)
Deze informatie is zonder wijzigingen rechtstreeks van de website clinicaltrials.gov gehaald. Als u verzoeken heeft om uw onderzoeksgegevens te wijzigen, te verwijderen of bij te werken, neem dan contact op met register@clinicaltrials.gov. Zodra er een wijziging wordt doorgevoerd op clinicaltrials.gov, wordt deze ook automatisch bijgewerkt op onze website .