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Pediatrics. 2009 Oct;124(4):1076-84. doi: 10.1542/peds.2009-0237. Epub 2009 Sep 14.

Implementation of and barriers to routine HIV screening for adolescents.

Author information

1
Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee 38105, USA. timothy.minniear@stjude.org

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 (> or =15 years; P.002), female (P=.003), and nonwhite (P=.006). Older patients (> or =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, optout, HIV screening, regardless of gender or race, and a computerized reminder enhances screening.

PMID:
19752084
DOI:
10.1542/peds.2009-0237
[Indexed for MEDLINE]

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