Published online September 14, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1076-1084 (doi:10.1542/peds.2009-0237)
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ARTICLE

Implementation of and Barriers to Routine HIV Screening for Adolescents

Timothy D. Minniear, MDa,b, Barry Gilmore, MDb, Sandra R. Arnold, MDb, Patricia M. Flynn, MDa,b,c, Katherine M. Knapp, MDa,b and Aditya H. Gaur, MDa

a Department of Infectious Diseases, St Jude Children's Research Hospital, Memphis, Tennessee
Departments of b Pediatrics
c Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee

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.

Key Words: Centers for Disease Control and Prevention • HIV • screening • opt-out • adolescents

Abbreviations: CDC—Centers for Disease Control and Prevention • ED—emergency department • LBCMC—Le Bonheur Children's Medical Center • CI—confidence interval

Accepted Jun 2, 2009.


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