Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department

Area of Science:

• Pediatric Emergency Medicine
• Public Health
• Infectious Disease Epidemiology

Background:

• Pediatric emergency departments (PEDs) are critical touchpoints for adolescent healthcare.
• HIV screening practices in PEDs vary, with targeted testing often relying on provider-initiated risk assessment.
• Gaps in risk assessment can lead to missed opportunities for diagnosing adolescent HIV infections.

Observation:

• A prospective study compared targeted HIV testing with routine HIV screening in a PED over four months.
• Targeted testing identified 107 adolescents, while routine screening approached 344.
• Routine screening identified one positive case in a 14-year-old who had been missed by targeted testing during previous visits.

Findings:

• Routine HIV screening in PEDs identified more adolescents for HIV testing compared to targeted testing alone.
• Targeted testing disproportionately screened older females and those with genitourinary concerns, potentially missing other at-risk individuals.
• While moderate agreement existed between provider documentation and adolescent perception of risk assessment (κ = 0.61), targeted testing missed adolescents with identified HIV risk factors.

Implications:

• Routine HIV screening in PEDs is more effective at identifying HIV-positive adolescents than targeted testing.
• Implementing routine HIV screening can help close critical gaps in adolescent HIV diagnosis and care within emergency settings.
• This strategy expands the reach of HIV testing to a broader adolescent population in the PED, enhancing public health outcomes.