Infectious disease screening in a dedicated primary care clinic for children in foster care
Sarah Lairmore1, Kimberly E Stone2, Rong Huang3
1University of Texas Southwestern Medical School, 5323 Harry Hines Blvd., Dallas, TX 75219, United States.
Insights
Children in foster care have a high risk of infectious diseases. Screening practices in a dedicated clinic showed few positive results, suggesting targeted screening may be appropriate.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Children in foster care are a high-risk population for infectious diseases.
- Guidelines recommend screening for tuberculosis, hepatitis B and C, syphilis, gonorrhea, and chlamydia.
- Limited data exists on the prevalence of infectious diseases in this population.
Purpose of the Study:
- To describe infectious disease screening practices.
- To evaluate screening in a primary care clinic for children in foster care.
Main Methods:
- Retrospective chart review.
- Analysis of data from a foster care primary care clinic at a southwestern academic center.
- Inclusion of 2868 unique patients evaluated between January 1, 2017, and December 31, 2018.
Main Results:
- 57% of patients had at least one infectious disease screening.
- Approximately 50% completed screenings for tuberculosis, HIV, syphilis, and hepatitis C.
- Positive screens included 3.6% for tuberculosis, 5.5% for chlamydia in adolescents, and <1% for HIV, syphilis, or hepatitis C.
Conclusions:
- Few positive infectious disease screenings were found despite identified risk factors.
- Increased visits to the clinic correlated with higher screening completion rates.
- Age and local epidemiology-targeted screening may be clinically appropriate and less traumatizing.
Background:
Children in foster care are considered at high risk for infectious diseases, and guidelines recommend screening for tuberculosis, hepatitis B and C, syphilis, gonorrhea and chlamydia. Little is known about the prevalence of infectious disease in children in foster care.
Objectives:
Describe infectious disease screening practices in a primary care clinic dedicated to caring for children in foster care.
Participants And Setting:
Patients evaluated at a foster care primary care clinic at a southwestern academic center.
Methods:
Retrospective chart review.
Results:
From January 1, 2017 through December 31, 2018, 2868 unique patients were evaluated (53 % male, 41 % white, 30 % black, 19 % Hispanic); 1638 (57 %) had any infectious disease laboratory screening done. About 50 % of children had completed screens for tuberculosis, HIV, syphilis and hepatitis C. Tuberculosis screens were positive in 3.6 % of children, 5.5 % of adolescents were positive for chlamydia and <1 % of children were positive for HIV, syphilis or hepatitis C. Increasing age and number of visits were associated with completed tuberculosis, HIV, syphilis and hepatitis C screenings (p < 0.01); female adolescents with completed labs were more likely to be screened for gonorrhea and chlamydia than male adolescents.
Conclusions:
Few positive infectious disease screenings were identified in children evaluated in a dedicated foster care primary care clinic despite presence of risk factors. Multiple visits to a primary care foster care clinic may increase the likelihood of completed screenings. Targeted infectious disease screening based on age and local epidemiology may be less traumatizing but still clinically appropriate.
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