Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department

Abstract

Objectives: The aims of the study were (1) to compare targeted and routine HIV screening in a pediatric emergency department (PED) and (2) to compare provider documented HIV risk assessment with adolescent perception of HIV risk assessment conducted during the PED visit.

Methods: This prospective study ran concurrent to a PED routine HIV screening pilot. Adolescents could be tested for HIV by the PED provider per usual care (targeted testing); if not tested, they were approached for the routine screening pilot. A subset of adolescents completed a questionnaire on HIV risk. χ 2 analysis compared adolescents with targeted testing and routine screening. HIV-tested patients were asked if HIV risk was assessed; κ analysis compared this with documentation in the provider note.

Results: Over 4 months, 107 adolescents received targeted testing and 344 received routine screening. One 14-year-old patient tested positive by routine screening; this adolescent had 2 PED visits without targeted testing within 60 days. Compared with routine screening, adolescents with targeted testing were more likely female (82% vs 57%, P < 0.001), 16 years or older (71% vs 44%, P < 0.001), or had genitourinary/gynecologic concerns (48% vs 6%, P < 0.001). Adolescents with HIV risk factors were missed by targeted testing but received routine screening. Adolescents with documented HIV risk assessment were more likely to receive targeted testing. There was moderate agreement (κ = 0.61) between provider documentation and adolescent perception of HIV risk assessment.

Conclusions: There are gaps in PED HIV risk assessment and testing, which may miss opportunities to diagnose adolescent HIV. Routine HIV screening addresses these gaps and expands adolescent HIV testing in the PED.

FIGURE 1.

Adolescent eligibility and participation in targeted HIV testing and the routine screening pilot. These adolescents could receive targeted testing at provider discretion but are not included in the sample or analyses. Exclusion criteria include: triage acuity level 1 (1), known HIV diagnosis (1), developmental delay and/or impairedmental status (70), and ineligible per provider (67). Reasons not approached include: discharged before able to be approached (123), repeat visits (68), and other (59). HIV testing of adolescents completing questionnaires: targeted testing (19), routine screening pilot (35), and declined testing (46).