Adolescents presenting at a primary care clinic focused on improving HIV screening rates using rapid screening methods and physician collaboration were more than 1,000% more likely to be screened for infection, according to research published in Pediatrics.
“Universal HIV screening beginning in adolescence is recommended by the CDC and the United States Preventive Services Task Force,” Renata Arrington-Sanders, MD, MPH, ScM, associate professor of pediatrics at the Johns Hopkins University School of Medicine, and colleagues wrote. “However, pediatric primary care settings have low rates of HIV screening because of poor awareness of guidelines, concerns over confidentiality and screening barriers such as time constraints and a lack of training in providing results.”
The researchers added that because youths are more likely to receive health care and screenings in primary care, physicians practicing in this setting are an important part of improving HIV screening rates.
Between March 2014 and June 2015, Arrington-Sanders and colleagues conducted a four-part quality improvement study at an academic pediatric primary care practice located in an area with a high prevalence of HIV. The clinic provided care to patients aged 25 years and younger.
The quality improvement intervention included collaboration between a team of medical directors, nurse managers, social workers and certified health educators from both primary care and HIV clinics. The group met weekly to review screening in the primary care practice.
According to the researchers, 4,433 visits occurred for patients aged between 13 and 25 years were identified as candidates for screening based on CDC recommendations. However, the baseline HIV screening rate was only 29.6% at the beginning of the study.
Arrington-Sanders and colleagues observed a spike in screenings by the end of the study, with 82.7% of eligible patients screened for infection. At the end of phase one, patients were 31% more likely to be screened for HIV (OR = 1.31; 95% CI, 1.01-1.69) when compared with baseline screening rates. A 1,272% increase was observed in screening rates at the end of phase four when compared with baseline screening rates (OR = 12.72; 95% CI, 10.45-15.48).
Most patients at the clinic screened for HIV received a rapid screening method (90.4%). This type of screening, according to the researchers, provided more same-day results for patients.
During the study, five patients tested positive for HIV and were linked to HIV care on-site on the same day as their screening. The researchers wrote that three of the five patients were still in care by the end of the study.
“High screening rates in the current study may be a result of removing the stigma associated with requesting an HIV test by offering routine opt-out rapid tests,” Arrington-Sanders and colleagues wrote. “Data reveal that youth prefer to be offered screening for HIV rather than asking for it. Not requiring explicit parental consent for HIV screening may also have promoted screening among younger patients. Previous work reveals that minors perceive the requirement of parental consent to be a barrier to accessing HIV screening.” – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.