The CDC estimates that youth account for 25% of all new HIV infections in the United States. HIV testing remains low among adolescents with only 22% of sexually active high school students reporting having ever been tested. Despite CDC guidelines for routine HIV testing of patients 13-64 years, pediatricians have not adopted routine opt-out testing protocols as best practice. UCSF Benioff Children’s Hospital Oakland (UBCHO) is one of only two pediatric institutions with such a protocol.
Routine opt-out testing was implemented at UBCHO utilizing Abbott® 3rd and 4th generation tests in January 2014. A Best Practice Advisory (BPA) alert was incorporated in the electronic medical record (EMR) to prompt clinicians to provide opt-out HIV testing for eligible patients. The BPA determines eligibility based on the following algorithm: patient is +13 years old, has not had an HIV test in the past 6 months, and is not known to be HIV infected. Data was extracted from the EMR for demographics, offer rates and testing rates.
Routine opt-out testing increased the number of adolescent patients tested from 2,213 at baseline in 2013 to 3,176 and 4,302 in 2014 and 2015 respectively. A total of 8,561 HIV tests have been performed in the 2.5 years since implementation. Testing rates increased from 3,176 of 16,966 eligible patients (19%) tested in 2014 to 4,302 of 15,562 (28%) tested in 2015. In 2014, 4 new infections were identified (seroprevalence rate of 0.13%) and 1 new infection in 2015 (seroprevalence of 0.07%). Three of the 5 infections were Acute HIV Infection (AHI). Overall, testing has resulted in 24 screened positives: 5 true positives (3 AHI), 1 “Quantity Not Sufficient” and 18 false positive.
While originally implemented as physician initiated testing, lower than expected testing rates in critical settings like emergency departments has necessitated additional creative strategies such as nurse initiated testing. With the high rates of new HIV infections among adolescents in the United States, routine testing presents a unique opportunity for early intervention, identification of HIV infected youth, and initiation of
A. Petru, Gilead Sciences: Collaborator , Grant recipient