Three Pilot Randomized Controlled Trials Evaluating a Persuasive Health Communication Intervention for Adult Emergency Department Patients Declining HIV/HCV Testing.

Background: The lack of evidence-based interventions to overcome patient refusal limits the success of emergency department (ED)-based HIV and hepatitis C virus (HCV) testing for diagnostic purposes or screening. We created a persuasive health communication intervention (PHCI) designed to overcome ED patient reluctance to accept HIV/HCV testing. In three pilot randomized controlled trials (pRCTs), we evaluated the performance of the PHCI when delivered by video or in-person by an HIV/HCV counselor, and as compared to a control condition video. Methods: Adult ED patients who declined HIV/HCV screening were enrolled. Participants were randomly assigned (1:1 allocation) in each pRCT as follows: pRCT 1: PHCI video vs. control condition video; pRCT 2: PHCI delivered in-person by HIV/HCV counselor vs. control condition video; and pRCT 3: PHCI delivered in-person by HIV/HCV counselor vs. the PHCI video. The primary outcome for each pRCT was acceptance of HIV/HCV testing post-intervention. Results: Acceptance of HIV, HCV or both tests post-intervention was: pRCT 1: PHCI video (n = 27) vs. control condition video (n = 28), 29.6% vs. 10.7%; p = 0.08; pRCT 2: PHCI delivered in-person by HIV/HCV counselor (n = 30) vs. control condition video (n = 30), 10.0% vs. 26.7%; p = 0.09; and pRCT3: PHCI delivered in-person by HIV/HCV counselor (n = 29) vs. the PHCI video (n = 29), 48.3% vs. 34.5%; p = 0.29. Conclusions: The results from these pRCTs are encouraging. ED patients who initially declined HIV/HCV testing can be persuaded instead to be screened for these infections. The PHCI, whether delivered in-person by an HIV/HCV counselor or video, is a promising intervention to encourage screening for these infections.