An Online Audio Computer-Assisted Self-Interview for Pre-screening Prior to Rapid HIV Testing in a Vulnerable Population Authors: Alwyn T. Cohall, MD 1 , Yalini Senathirajah, MA 2 , Sheila Dini, BS 1 , Andrea Nye, MPH 1 , Donald Powell, CASAC-T 3 , Borris Powell, BS 3 1. Harlem Health Promotion Center, Columbia University, New York, NY 2. Department of Biomedical Informatics, Columbia University, New York, NY 3. Gay Men of African Descent (GMAD), New York, NY Abstract ACASI (Audio Computer-Assisted Self-Interview) has been demonstrated to be more effective than face to face interviews in eliciting truthful responses on sensitive subjects such as substance abuse and sexual behavior (1, 2). Thus, ACASI has the potential to streamline and standardize HIV counseling and testing by providing a comprehensive overview of each patient’s behavior while highlighting areas that may merit further exploration. Introduction It is essential that counselors at HIV testing centers have a complete and accurate psychosocial profile on patients before HIV testing ensues. Unfortunately, efficient and effective counseling in community and clinical settings can be logistically difficult given issues related to health literacy and provider variability in counseling approaches. "HARI" (HIV Assessment of Risk Inventory) With support from Abbott Laboratories Inc., we created an ACASI-based closed online system that allows patients to answer questions delivered by voice via headphones and in writing on a computer screen in a private space within a community-based program providing HIV counseling and testing to gay and bisexual men of color (Table 1). Central DB Internet Client HIV Testing Center Staff printout Figure 1. ACASI schematic Questions include items examining substance abuse, violence, family and social support, sexual risk taking, depression, prior testing experiences and access to medical services. Answers are submitted with an identifier to a central data-base. The counselor can then access a web page that presents a color-coded summary of the patient's responses. A rule-based algorithm highlights areas of concern and provides a summary response as to whether the patient should be tested or offered other interventions prior to testing, such as psychological services or substance abuse counseling (Table 2). Figure 2. Excerpt from ACASI counselor print-out Conclusion HIV counseling and testing require clear and effective protocols to ensure that patients receive the appropriate services. ACASI technology has been well-received by high-risk patients, and has the potential to streamline and standardize assessments while providing counselors with an easy to interpret patient overview prior to each counseling session. The program is now in the implementation phase and we will be reporting results in the near future. References 1. Metzger DS, Koblin B, Turner C, Navaline H, Valenti F, Holte S, et al. Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000 Jul 15;152(2):99- 106. 2. Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science. 1998 May 8; 280(5365):867-7. AMIA 2007 Symposium Proceedings Page - 915