Implementation of and Barriers to Routine HIV Screening for Adolescents

Abstract

OBJECTIVES: We developed and implemented a process for routine HIV screening, and we report screening practices and acceptance among adolescents at a large, urban, pediatric emergency department (ED). METHODS: We surveyed health care providers regarding their knowledge and beliefs about HIV and generated a protocol for routine HIV screening. Free, routine, opt-out, HIV screening was offered for all adolescents (13–18 years of age) presenting for care in the ED. We studied ED HIV screening rates, rates of test acceptance among patients/guardians, patients' reasons for opting out, and HIV prevalence. A computerized prompt in the electronic chart was introduced 5 months after initiation, to address low screening rates. RESULTS: Of the 118 health care providers who responded to the preimplementation survey, 78% were unaware of the revised HIV testing guidelines and 58% predicted that routine screening would fail because of patient or guardian refusal. Of the 5399 patients who qualified for routine screening, 37% (2002) were offered opt-out screening. Of those, 13% opted out. Patients offered screening were more likely than patients not offered screening to be older (≥15 years; P = .002), female (P = .003), and nonwhite (P = .006). Older patients (≥15 years of age) who were approached for screening were less likely to opt out (P = .002). Computerized prompting improved screening rates. One of the 1735 tests (0.57 per 1000 tests) performed yielded positive results for HIV. CONCLUSION: Adolescents and their guardians accept routine, opt-out, HIV screening, regardless of gender or race, and a computerized reminder enhances screening.