The US Centers for Disease Control and Prevention (CDC) and the US Preventive Services Task Force (USPSTF) recommend universal HIV screening beginning in adolescence, but pediatric primary care settings have low rates of HIV screening.
Dr. Renata Arrington-Sanders and colleagues from Johns Hopkins University School of Medicine, Baltimore, MD, investigated whether implementing rapid HIV screening as standard practice improved screening rates among patients aged 13 to 25 in a pediatric primary care setting.
The research team used a four-cycle plan-do-study-act (PDSA) quality improvement model.
CHEs approached all eligible patients during clinic visits to obtain verbal consent for screening and to provide patients an opportunity to opt out of screening. Those who accepted screening were offered a third-generation oral rapid HIV test, and those reporting recent risk behaviors were screened using a serologic fourth-generation antigen and/or antibody test.
The HIV screening rate increased from 29.6% at baseline to 82.7% during cycle 4, when CHEs were colocated with providers and began to document reasons why rapid screening was not completed.
Overall, five patients were identified as HIV-positive during the program, and all of these patients were linked on the same day to on-site HIV care, according to the October 16 Pediatrics online report.
Only 2.9% of the HIV screening tests at baseline were rapid (97.1% were serology), but this increased to 94.0% in cycle 4.
Almost all patients (98.1%-100%) who received a rapid screening test received same-day results, compared with only 8.2%-28.6% of those screened via serology, who received their results an average of 18 to 81 days later.
"This study reveals that a system-level strategy in which established clinical structures are leveraged can improve the use of routine opt-out rapid HIV screening, receipt of results, identification of individuals who were unaware of their HIV status, and linkage to care," the researchers conclude. "Expanding routine opt-out HIV screening in primary care is needed to address the HIV epidemic in youth. Such programs can be easily integrated and may be effective in reaching those who might not otherwise seek testing or be screened for HIV."
Nellie R. Lazar from Children's Hospital of Philadelphia, who recently identified high rates of missed opportunities for HIV testing in adolescents, told Reuters Health by email, "Health educators can be a great addition to primary care practices that serve adolescents. However, not all practices will be able to afford them, so RNs and medical assistants can be trained to do point-of-care rapid HIV testing on all patients instead."
"Those who are identified as high risk by the nurse, MA, or provider can then be referred to more intensive risk reduction counseling when available," she said. "The electronic medical record can also be a helpful tool to provide alerts to clinical staff for those patients who have not had an HIV test in the past to encourage providers to order testing."
"It is encouraging to see the remarkable increase in routine testing for HIV that can be achieved through quality improvement interventions," Lazar said. "Testing all patients for HIV according to CDC recommendations can take away the stigma of testing and result in the identification of HIV-positive youth who can be linked directly to care, as shown in this report."