Implementation of and Barriers to Routine HIV Screening for Adolescents

In the current study, researchers developed and implemented a process to facilitate routine HIV screening among adolescents ages 13-18 in a large urban pediatric emergency department (ED).

The authors surveyed health care providers about their knowledge and beliefs about HIV, and they developed a protocol for free, opt-out HIV screening of patients. Five months after the study's launch, researchers deployed an automatic prompt in the electronic chart to address low testing rates.

In total, 118 health workers responded to the survey: 78 percent were unaware of CDC's revised HIV testing guidelines, and 58 percent predicted consent would be declined by the patient or guardian. Among 5,399 qualified patients, 37 percent (2002) were offered opt-out screening, and only 13 percent declined testing. Those offered screening were likelier than other patients to be older (age 15 or older; P=.002), female (P=.003), and nonwhite (P=.006). Patients age 15 and older were less likely to decline testing (P=.002). Testing rates improved with the automatic prompt. Among 1,735 tests, one yielded a positive result for HIV (0.57 per 1,000 tests).

"Adolescents and their guardians accept routine, opt-out HIV screening, regardless of gender or race, and a computerized reminder enhances screening," the authors concluded.

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