Enhancing Adolescent HIV Screening: A Quality Improvement Approach Using Point-of-care Testing in an Outpatient Pediatric Setting

Routine HIV testing remains poorly implemented nationwide, despite national recommendations. Half of adolescents who are HIV positive do not know their status. This quality improvement project aimed to increase the rate of routine HIV screening during well-child checks (WCCs) for eligible adolescents 15-18 years of age with no prior lifetime HIV test to greater than 50% within 1 year through implementation of point-of-care (POC) oral swab HIV testing at a pediatric outpatient clinic affiliated with Loma Linda University in Moreno Valley, Calif.

All adolescent patients 15-18 years of age presenting for WCC who had not yet been tested once in their lifetime for HIV were eligible. We conducted 6 plan-do-study-act cycles from August 2023 to September 2025, including initial and subsequent implementation cycles. Key drivers included standardizing the process to facilitate HIV testing in the clinic, improving provider awareness, providing standardized information on patient eligibility, and providing patient and family education on HIV screening. The primary intervention was implementing oral swab POC testing during WCC visits. Other interventions included creating an educational curriculum for physicians on HIV screening guidelines, developing multilingual resources for families on the importance of HIV screening, and using a multidisciplinary team to integrate testing into clinic workflow. The primary outcome measure was the monthly percentage of adolescents 15-18 years of age who were screened for HIV via the POC swab during their WCC.

Before implementation, the average percentage of eligible patients screened from January 2023 to July 2023 was 29%. Screening rates increased from 29% to 51% among eligible adolescents over the first eight months. With implementation of the POC oral swab HIV test, screening rates increased from 51% to 56% over an additional 8 months. During the later implementation cycles (December 2024 to September 2025), monthly screening rates generally exceeded the project goal of 50%, averaging 64%. Eligibility was based on age, visit type, and prior lifetime HIV testing status. No reactive or positive HIV test results were identified during the study period. Potential balancing measures included additional time needed during clinical visits, false-positive results, and the potential workflow burden on clinical staff.

Improving HIV screening among adolescents is feasible through a multicomponent quality improvement strategy that incorporates POC rapid antibody testing. This type of testing is painless, can be performed quickly during clinic visits, and improves patient confidentiality because results are available at the time of the visit rather than by phone or email. Medicaid covers POC testing for HIV. This makes this form of testing feasible in many clinics.