The effectiveness of a follow-up program at improving HIV testing in a pediatric emergency department

HIV infection is on the rise in the adolescent population, with the most common risk for infection being sexual exposure for youth aged 15-24 years. Therefore screening for HIV infection should be performed on adolescent patients presenting to the emergency department (ED) with signs or symptoms of sexually transmitted disease (STD). Lack of opportunity for follow-up of HIV test results may prevent ED physicians from obtaining this test.

Our objective was to compare the rate of HIV testing in patients evaluated in the ED for STDs before and after the implementation of a follow-up program.

We conducted a retrospective chart review of all patients 12-18 years of age seen in the ED between April 1, 1993 and March 31, 1997 with ICD-9 codes for STD. The follow-up program started April 1, 1995. Rates of HIV testing were compared between the two years before and after the institution of the follow-up program to determine whether the follow-up program had an impact on the rate of HIV testing.

We reviewed 862 records. Before the follow-up program was in place, 86 (18%) of the patients tested for STD in the ED were also tested for HIV and only 7 (8.1%) were called back with their results. After the follow-up program was in place, 100 (27%) of the patients tested for STD in the ED were also tested for HIV. Attempts were made to notify 57 (57%) of these patients of their HIV test results. Coincident with the implementation of the follow-up program, both the rate of HIV testing and patient notification of HIV results increased (p < 0.05).

Coincident with the institution of an appropriate follow-up system, HIV testing in the ED increased and follow-up of these patients improved. However, further steps should be taken to improve the HIV testing in the pediatric ED.