Background:
The most powerful motivator for behavior change is knowledge of HIV status, yet 250,000 people in the US remain unaware of their infection. New methods are needed to overcome barriers to HIV testing. To make rapid HIV testing feasible in emergency department settings, with Resources Online, we developed a computer counseling tool (Rapid Test Computer Assessment and risk Reduction Education or CARE tool) that uses a tablet pc to provide counseling and consent for rapid HIV testing.

Objective:
To evaluate the acceptability and feasibility of computer assisted rapid HIV testing in a busy urgent care setting.

Method:
Participation was offered to clients presenting to an urban urgent care. Participants were randomized to either computer assisted rapid HIV testing before their clinical visit, or to chart review only. Both groups completed a brief in-person exit survey. Acceptability of the Rapid Test CARE tool was assessed, and knowledge of HIV status was compared between the arms.

Result:
Among 971 clients approached, 54% accepted the study. Among participants completing the CARE tool (n=239) 63% were male, and 54% were people of color. Among those using the CARE tool, 97% found the tool easy to use, 97% found the experience (delivered in a busy hallway) to be private enough, 86% found the length (about 30 min.) to be just right, 91% found it to be helpful compared to staff-based counseling, and 68% preferred computer counseling to staff counseling if they had to test again. All participants completing the Rapid Test CARE tool received rapid HIV test results. In the chart review arm 3% were offered standard HIV testing.

Conclusion:
Computer-assisted rapid HIV testing using CARE is acceptable and feasible in a busy urban urgent care setting.

Implications:
If widely implemented, computer-assisted rapid testing could enhance access to HIV test status among at-risk populations.