Unique Needs for the Implementation of Emergency Department HIV Screening in Adolescents

Background The Centers for Disease Control and Prevention recommend universal HIV screening starting at 13 years, which has been implemented in many general US emergency departments (EDs) but infrequently in pediatric EDs. We aimed to 1) implement a pilot of routine adolescent HIV screening in a pediatric ED and 2) determine the unique barriers to CDC recommended screening in this region of high HIV prevalence. Methods This was a prospective four-month implementation of a routine HIV screening pilot in a convenience sample of adolescents 13-18 years at a single pediatric ED, based on study personnel availability. Serum-based 4th generation HIV testing was run through a central laboratory. Parents were allowed to remain in the room for HIV counseling and testing. Data were collected regarding patient characteristics and HIV testing quality metrics. Comparisons were made using chi square and Fisher's exact tests. Regression analysis was performed to assess for an association between parent presence at the time of enrollment and adolescent decision to participate in HIV screening. Results Over four months, 344 of 806 adolescents approached consented to HIV screening (57% female, mean 15.1 years). Adolescents with HIV screening were more likely to be older than those who declined (p = 0.025). Other blood tests were collected with the sample for 21% of adolescents; mean time to result was 105 minutes (interquartile range 69, 123) and 79% were discharged before the result was available. Having a parent present for enrollment was not associated with adolescent participation (adjusted odds ratio 1.07, 95% CI 0.67-1.70). Barriers to testing included: fear of needlestick, time to results, cost, and staff availability. One of 344 tests was positive in a young adolescent with Stage 1 HIV. Conclusions Routine HIV screening in adolescents was able to be implemented in this pediatric ED and led to the identification of early infection in a young adolescent who would have otherwise been undetected at this stage of disease. Addressing the unique barriers to adolescent HIV screening is critical in high prevalence regions and may lead to earlier diagnosis and treatment in this vulnerable population.