Background: Undiagnosed sexual partners with HIV infection may contribute to up to 30% of new infections annually. Routine HIV screening of high risk populations has been shown to be effective and is recommended by the CDC. Despite this recommendation, many adolescents are not screened. The negative impact on the adolescent population from inadequate screening has not been fully quantified.
Methods: Through a retrospective chart review, the course prior to diagnosis of HIV-infected adolescents diagnosed at Childrens Medical Center Dallas (CMC) and Parkland Hospital (PH, the proximate adult county hospital with a universal HIV screening program) was reviewed. Subjects were included if they had a confirmed, positive HIV test between 13 and 21 years of age, and excluded if they had a previous HIV diagnosis. Inpatient, outpatient, and ED encounters at CMC and PH following the subjects 13th birthday and before their HIV diagnosis were quantified. Missed opportunity encounters (MOE) were defined as above encounters where there was no HIV screen performed that took place after the date 3 months following their most recent HIV screen. Data were collated by facility and compared.
Results: 204 subjects met inclusion criteria: 140 (69%) male, 155 (76%) black, and 87 (43%) followed by CMC. There were 412 total encounters (2.02 per subject) out of which 284 (1.39 per subject) qualified as MOE. Seventy-two subjects had at least one MOE. At the CMC ED, there were 6.7 MOE for every new HIV adolescent diagnosis, compared to PH ED where there were 0.9 (p < 0.01) [Fig 1]. Adolescents identified through the PH ED were older (PH, 18.8 yrs vs. CMC, 16.1 yrs, p<0.01) [Fig 2], and had a trend towards a lower CD4 count (PH, 337 cells/m3 vs. CMC, 449 cells/m3, ns). Three adolescents were identified with AIDS (CD4<200) through HIV screening at PH, vs 1 at the CMC ED.
Conclusion: Missed opportunity encounters for HIV screening of adolescents are greater in number in pediatric emergency departments without universal screening programs, as compared to similar adult settings with such a program. Implementing a universal HIV screening protocol at pediatric EDs in HIV endemic areas may help to identify HIV-positive adolescents at younger ages and improve long term outcomes.
G. Warraich, None
K. Costello, None
S. Dietz, None
A. Evans, None