Effect of Opt-Out HIV Testing for Adolescent Patients on a Pediatric Hospital Medicine Service

In 2023, our emergency department, serving a region with one of the highest rates of new HIV infection, implemented Centers for Disease Control and Prevention-recommended universal, opt-out HIV screening for adolescents. However, few patients admitted to the pediatric hospital medicine service (PHM) were tested. To address this gap, we aimed to expand universal, opt-out HIV testing to PHM and evaluate screening implementation.

In this pre-postintervention study, we compared HIV testing rates for patients admitted to PHM aged 13 years or older during 5 months preimplementation and postimplementation (February to June 2024 and July to November 2024). Clinicians received regular education on HIV screening guidelines and opt-out language and were encouraged to incorporate screening in confidential psychosocial assessments. If the inpatient team did not offer testing, HIV navigators counseled adolescents, regardless of parental presence. Testing rates were compared with chi-square and Welch's t-test.

There was a 38% increase in HIV screening from the preimplementation to postimplementation periods (preimplementation, 12.4%; postimplementation, 17.1%; P = .04). Postimplementation, 533 adolescents were eligible for HIV screening; 148 were approached, and 91 HIV tests were ordered (17.1% of eligible; 64% girls; mean age 16 ± 1.8 years), identifying one adolescent with HIV (>1% seroprevalence; 3% for boys). Adolescents were significantly more likely to be tested when approached by an HIV navigator than during a confidential interview (P = .004). Parental presence did not negatively impact adolescent participation.

Adopting universal, opt-out HIV screening with HIV navigators in the inpatient setting significantly increased testing rates. Further studies on the most effective and sustainable approach to screening are needed.