Randomised Study Comparing Two HIV Screening Strategies
Condition: HIV Infections
MeSH terms: HIV Infections
Study type: Interventional

Summary: 
      A randomised, single-blind study (the study investigator will not know which arm each patient
      is assigned to) conducted to examine the most effective strategy for conducting HIV testing
      in the Emergency Department (ED) using an electronic tablet. The study will take place in the
      ED at Lausanne University Hospital (LUH) between August and December 2015 in the context of
      the Masters project of a medical student studying at the Faculty of Medicine at Lausanne
      University.
    

Detailed description: 
      In Switzerland, the national HIV testing recommendations have proposed targeted and
      diagnostic HIV testing since 2007. These recommendations list medical conditions and
      populations at risk in which HIV testing is indicated. The difficulty with this targeted
      approach is that it relies on medical personnel 1) to be aware that the medical conditions
      listed have an association with HIV infection and 2) to be able to identify their patients as
      coming from at-risk populations. In other countries, notably the United States, France and
      the United Kingdom, national HIV testing recommendations propose non-targeted screening
      whereby everyone presenting to a medical facility is tested if the HIV seroprevalence in the
      catchment population is above a defined threshold (0.1% for the US and France; 0.2% for the
      UK). As HIV seroprevalence in Switzerland already exceeds these thresholds, the current study
      will be performed to see whether non-targeted HIV testing using electronic tablets is
      acceptable and feasible in our Emergency Department (ED).

      ED patients will be randomised to a targeted or non-targeted arm after consenting to
      participate. Eighty patients will be assigned to each study arm. Participating patients will
      be issued with an electronic tablet and invited to follow the instructions on the screen.
      Targeted arm patients will be invited to complete a questionnaire on HIV risk factors and, if
      one or more risk factors are present, they will be informed that HIV testing is indicated and
      will be invited to take a free rapid HIV test. Non-targeted arm patients will be provided
      with information about HIV and HIV testing and will then be invited to take a free rapid HIV
      test without any questions regarding risk factors. Patients in each arm who are either not
      offered (targeted arm) or who decline rapid testing (non-targeted arm) will undergo secondary
      cross-screening in which targeted arm patients will be automatically directed by the tablet
      to the non-targeted arm information page and non-targeted arm patients will be directed to
      the targeted arm questionnaire. The primary endpoint is patient acceptance of HIV testing.
      The secondary objective is to examine the effect of cross-screening strategies.
    

Intervention name(s): Rapid HIV test
Intervention type(s): Diagnostic Test
Other intervention name(s): INSTI
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Randomised, single-blind study
Masking: Double (Care Provider, Investigator)
Primary purpose: Screening
Keywords: HIV testing