P3.016: Improving Adolescent HIV Testing in the Pediatric ED: Innovations, Challenges, and Next Steps

Purpose/Objectives: The Centers for Disease Control recommends human immunodeficiency virus (HIV) testing at least once per lifetime in people aged 13 – 64 years old. The American Academy of Pediatrics recommends testing in sexually active youth annually. More frequent testing is indicated for people diagnosed with other sexually transmitted infections (STIs), men who have sex with men, or those with multiple unprotected sexual encounters. In 2022, 20% of new HIV diagnoses were in people ages 13 to 24. There is an opportunity to increase HIV testing in emergency departments (ED), yet universal opt-out testing can be cumbersome and complicated. In our pediatric ED, only 44% of patients were tested for HIV when other STI testing was obtained. We sought to improve HIV testing in this high-risk adolescent population from 44% to 60% over 9 months and sustain for 12 months.

Design/Methods: A multidisciplinary team created a key driver diagram after data and process review. Interventions were implemented using PDSA methodology. An HIV prevention team was created and took responsibility to follow-up all positive gonorrhea and syphilis tests. If empiric treatment was not provided in the ED, the team worked to have patients return to their primary care office for treatment as well as HIV testing, if not obtained at the initial ED visit. Additionally, we modified our well-used ED STI order set in the electronic medical record (EMR), so that an HIV test was defaulted, and to not order required manually unchecking.

Results: The ED increased HIV screening in adolescents being tested for other STIs from a baseline of 44% to at most 52%, but this varied monthly. The goal of 60% was not achieved. No increase in testing occurred after the first intervention, but after EMR modification, the overall number of HIV tests increased from an average of 27 to an average of 39 per month.

Conclusion/Discussion: Modifying the EMR in a frequently used order set modestly increased HIV testing rates in patients being tested for other STIs in the ED. However, because nurse-initiated STI lab ordering protocols were also frequently used, the impact of this provider-based intervention was less than expected. Following up with patients with positive STI testing in the ED, did not increase HIV testing, especially in those empirically treated during their ED visit. Using QI methodology, we can use our results to inform our future interventions to improve rates including strategies to increase nurse-initiated HIV testing and approaching adolescent patients during triage to offer HIV testing at their visit.