Pediatric Emergency Department HIV Screening Increases Testing in Adolescents Leading to Earlier Diagnosis and Linkage-to-Care
Abstract
The Centers for Disease Control and Prevention recommends HIV screening for patients ≥13 years. Parts of Atlanta has HIV positive rates 8-times the national average. Adolescents are least likely to know their HIV status, have the lowest rate of linkage to care, and viral suppression. Children’s Healthcare of Atlanta (Children’s) implemented opt-out HIV testing in its emergency departments (ED) for patients ≥13 years undergoing venipuncture in 2 of their 3 sites. The objective is to increase testing leading to earlier HIV diagnosis and linkage-to-care.
Children’s electronic medical record EPIC and its population discovery tool were used to compare testing volumes of 13–24-year-olds, 21 weeks pre and post the July 6th, 2023, clinical implementation. Data for all 3 sites was reviewed but only 2 sites received educational promotion. Results were cross-referenced to determine newly diagnosed adolescents living with HIV (ALHIV) from known positives. The data was compared using descriptive statistics.
There were 642 patients tested pre-implementation, 451(70%) girls and 191(30%) boys. Three new ALHIV were identified; 1 coinfected with syphilis, median age 17, assignment at birth was (2) male and (1) female. After 21 weeks, 892 patients were tested: 629(71%) girls and 263(29%) boys. Five new ALHIV; median age 16, assignment at birth was (4) male, 2 coinfected with syphilis, and (1) female. This demonstrates a positivity rate of nearly 1%. The initiative showed a 67% increase in newly diagnosed cases; all were linked to care.
Atlanta remains a hotspot for HIV cases. Five cases in 21 weeks highlights the importance of HIV testing and reflects a public health crisis. The initiative significantly increased HIV screening and will likely identify ALHIV at an earlier stage of infection, facilitating timely access to medical care. This can lead to improved clinical and immunological outcomes and a reduced risk of secondary transmission.
Keywords
o HIV; Pediatric; Adolescence; Emergency medicine; STI; Opt-Out; Preventative health
Pediatric Emergency Department HIV Screening Increases Testing in Adolescents Leading to Earlier Diagnosis and Linkage-to-Care
The Centers for Disease Control and Prevention recommends HIV screening for patients ≥13 years. Parts of Atlanta has HIV positive rates 8-times the national average. Adolescents are least likely to know their HIV status, have the lowest rate of linkage to care, and viral suppression. Children’s Healthcare of Atlanta (Children’s) implemented opt-out HIV testing in its emergency departments (ED) for patients ≥13 years undergoing venipuncture in 2 of their 3 sites. The objective is to increase testing leading to earlier HIV diagnosis and linkage-to-care.
Children’s electronic medical record EPIC and its population discovery tool were used to compare testing volumes of 13–24-year-olds, 21 weeks pre and post the July 6th, 2023, clinical implementation. Data for all 3 sites was reviewed but only 2 sites received educational promotion. Results were cross-referenced to determine newly diagnosed adolescents living with HIV (ALHIV) from known positives. The data was compared using descriptive statistics.
There were 642 patients tested pre-implementation, 451(70%) girls and 191(30%) boys. Three new ALHIV were identified; 1 coinfected with syphilis, median age 17, assignment at birth was (2) male and (1) female. After 21 weeks, 892 patients were tested: 629(71%) girls and 263(29%) boys. Five new ALHIV; median age 16, assignment at birth was (4) male, 2 coinfected with syphilis, and (1) female. This demonstrates a positivity rate of nearly 1%. The initiative showed a 67% increase in newly diagnosed cases; all were linked to care.
Atlanta remains a hotspot for HIV cases. Five cases in 21 weeks highlights the importance of HIV testing and reflects a public health crisis. The initiative significantly increased HIV screening and will likely identify ALHIV at an earlier stage of infection, facilitating timely access to medical care. This can lead to improved clinical and immunological outcomes and a reduced risk of secondary transmission.
