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Shakir RM, Doshi S, Blakeslee S, Jessee M. Seize the Opportunity: Increasing the HIV Screening Rate in Adolescents Presenting to a Community Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:801-806. [PMID: 37665966 DOI: 10.1097/pec.0000000000003044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Abstract
OBJECTIVES Our objective was to increase human immunodeficiency virus (HIV) screening in adolescents presenting to our community pediatric emergency department with symptoms suggestive of a sexually transmitted infection (STI) and who were being tested for gonorrhea and chlamydia. Specifically, we aimed to increase the monthly average proportion of adolescents concurrently screened for HIV in this target group from 11% to 50% in 6 months. METHODS We identified barriers to HIV screening, focusing on physician-related challenges and adolescents' concerns about confidentiality. We designed interventions targeting these barriers and implemented them in plan-do-study-act cycles beginning in February 2020. We educated physicians and nurses about screening recommendations, emphasized a physician-conducted private interview during which confidential contact information could be obtained, and assured confidentiality on after visit summaries by removing STI results. We also provided regular feedback to physicians on the screening rate. In addition, we implemented an electronic health record quick order set and a documentation tool. Using a statistical process control chart, we measured the average monthly proportion of adolescents in the target group who were offered HIV screening or tested for HIV before and after interventions. RESULTS A total of 140 adolescents in the target group presented to our pediatric emergency department from February 2020 through December 2021. After plan-do-study-act cycles, the average monthly screening rate increased to 80%. CONCLUSIONS Raising physician awareness of HIV screening recommendations and the importance of conducting a private interview improved screening rates. Assuring adolescent minors of confidentiality in a private interview, removing STI results from the after visit summary, and obtaining confidential contact information were important measures to overcome confidentiality barriers.
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Affiliation(s)
- Rashida M Shakir
- From the Children's Hospital of Philadelphia at Virtua Mount Holly Hospital, Mount Holly, NJ
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Gutman CK, Newton N, Duda E, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Camacho-Gonzalez A, Morris CR. Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1613-e1619. [PMID: 35686965 DOI: 10.1097/pec.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were (1) to compare targeted and routine HIV screening in a pediatric emergency department (PED) and (2) to compare provider documented HIV risk assessment with adolescent perception of HIV risk assessment conducted during the PED visit. METHODS This prospective study ran concurrent to a PED routine HIV screening pilot. Adolescents could be tested for HIV by the PED provider per usual care (targeted testing); if not tested, they were approached for the routine screening pilot. A subset of adolescents completed a questionnaire on HIV risk. χ 2 analysis compared adolescents with targeted testing and routine screening. HIV-tested patients were asked if HIV risk was assessed; κ analysis compared this with documentation in the provider note. RESULTS Over 4 months, 107 adolescents received targeted testing and 344 received routine screening. One 14-year-old patient tested positive by routine screening; this adolescent had 2 PED visits without targeted testing within 60 days. Compared with routine screening, adolescents with targeted testing were more likely female (82% vs 57%, P < 0.001), 16 years or older (71% vs 44%, P < 0.001), or had genitourinary/gynecologic concerns (48% vs 6%, P < 0.001). Adolescents with HIV risk factors were missed by targeted testing but received routine screening. Adolescents with documented HIV risk assessment were more likely to receive targeted testing. There was moderate agreement (κ = 0.61) between provider documentation and adolescent perception of HIV risk assessment. CONCLUSIONS There are gaps in PED HIV risk assessment and testing, which may miss opportunities to diagnose adolescent HIV. Routine HIV screening addresses these gaps and expands adolescent HIV testing in the PED.
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Affiliation(s)
| | | | | | | | | | - Martha Wetzel
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Janet Figueroa
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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3
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Bi L, Solnick RE, Merchant RC. A systematic review of HIV screening programs conducted in pediatric emergency departments in the United States. BMC Emerg Med 2022; 22:75. [PMID: 35524171 PMCID: PMC9074268 DOI: 10.1186/s12873-022-00633-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 04/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We conducted a systematic review of studies published in peer-reviewed journals on HIV screening programs conducted in pediatric emergency departments (PEDs) in the United States (US) with the objective of describing the methods, testing yields and challenges in these programs. METHODS We searched for full-text, English-language, original research articles focused on the conduct, development, initiation or implementation of any HIV screening program in a US PED through eight online databases (Pubmed (MEDLINE), Scopus, Embase, Cochrane, Web of Science, CINAHL, PsycInfo and Google Scholar) from their inception through July 2020. We also searched for articles on the websites of thirteen emergency medicine journals, 24 pediatric and adolescent health journals, and ten HIV research journals, and using the references of articles found through these searches. Data on HIV testing program components and yield of testing was extracted by one investigator independently and verified by a second investigator. Each program was summarized and critiqued. RESULTS Of the eight articles that met inclusion criteria, most involved descriptions of their HIV testing program, except for one that was focused on quality improvement of their program. Five described an opt-in and three an opt-out approach to HIV screening. Programs differed greatly by type of HIV test utilized and who initiated or performed testing. There were large variations in the percentage of patients offered (4.0% to 96.7%) and accepting (42.7% to 86.7%) HIV testing, and HIV seropositivity in the studies ranged from 0 to 0.6%. Five of the eight studies reported an HIV seropositivity greater than 0.1%, above Centers for Disease Control and Prevention recommended threshold for testing in a healthcare setting. CONCLUSIONS The studies illustrate opportunities to further optimize the integration of HIV screening programs within US PEDs and reduce barriers to testing, improve efficiency of testing results and increase effectiveness of programs to identify cases. Future research should focus on advancing the methodology of screening programs beyond feasibility studies as well as conducting investigations on their implementation and longer-term sustainability.
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Affiliation(s)
- Lynn Bi
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, MA, USA
| | - Rachel E Solnick
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Roland C Merchant
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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Leistikow PT, Patel V, Nouryan C, Cervia JS. Acceptability of HIV testing for adolescents and young adults by delivery model: a systematic review. J Investig Med 2021; 70:829-836. [PMID: 34880049 DOI: 10.1136/jim-2021-002056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 11/04/2022]
Abstract
HIV infections are prevalent among adolescents and young adults, of whom 44% remain unaware of their diagnosis. HIV screening presents numerous challenges including stigma, fear, and concerns about confidentiality, which may influence young people's acceptance of HIV screening and linkage to care differently from individuals in other age groups. It is imperative to understand which care delivery models are most effective in facilitating these services for youth. This systematic review analyzes the rates of HIV test acceptance and linkage to care by care delivery model for adolescents and young adults. Studies were classified into emergency department (ED), primary care/inpatient setting, community-based program, or sexually transmitted infection clinic models of care. From 6395 studies initially identified, 59 met criteria for inclusion in the final analyses. Rate of test acceptance and linkage to care were stratified by model of care delivery, gender, race, age ranges (13-17, 18-24 years) as well as site (North America vs rest of the world). A significant difference in acceptance of HIV testing was found between care models, with high rates of test acceptance in the ED setting in North America and primary care/hospital setting in the rest of the world. Similarly, linkage to care differed by model of care, with EDs having high rates of linkages to HIV care in North America. Future studies are needed to test mechanisms for optimizing outcomes for each care delivery model in addressing the unique challenges faced by adolescents and young adults.
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Affiliation(s)
- Peter Thomas Leistikow
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Vidhi Patel
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Health Innovations and Outcomes Research, Northwell Health, New Hyde Park, New York, USA
| | - Christian Nouryan
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.,Institute of Health Innovations and Outcomes Research, Northwell Health, New Hyde Park, New York, USA
| | - Joseph Steven Cervia
- Medicine and Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA.,Senior Medical Director, HealthCare Partners IPA & MSO, Garden City, New York, USA
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5
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Smith J, Broker P, Chakrabarty M, Santiago J, Farabaugh J, Piatt J, Samaddar K. Implementing Routine HIV Screening in an Urban Adolescent Population at a General Pediatric Clinic. J Adolesc Health 2021; 68:737-741. [PMID: 33129642 DOI: 10.1016/j.jadohealth.2020.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/08/2020] [Accepted: 09/08/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To increase the rate of routine HIV screening during preventative visits for adolescent patients aged 15 to 21 in a pediatric and adolescent clinic in accordance with national recommendations, which are poorly implemented nationwide. METHODS This was a quality improvement initiative. Four plan-do-study-act (PDSA) cycles were conducted from May 2016 to February 2020. Interventions included education of and reminders for the multidisciplinary team on guidelines and testing, creation of a standardized workflow, introduction of a rapid point-of-care HIV antibody test (POCT), and implementation of an opt-out, medical assistant/nursing-driven protocol for HIV rapid point-of-care testing. The primary outcome measure was the monthly percentage of adolescents screened for HIV during preventative visits. Data is presented in a p-control chart and means were adjusted for special cause variation according to the Institute for Healthcare Improvement guidelines. RESULTS Rates of routine HIV screening at preventative visits for youth ages 15 to 21 increased from the pre-intervention rate of 5.16% to a final rate of 41.5% over four PDSA cycles. Mean screening rates were adjusted after introducing the HIV POCT (+18.5%) and after implementing the medical assistant/nursing-driven protocol (+17.9%). CONCLUSIONS We successfully increased routine HIV screening rates at preventative visits for adolescents at an urban pediatric and adolescent clinic. This was in large part due to testing with a rapid HIV POCT and a clinic protocol allowing medical assistants and nurses to order the test under a physician's name as part of the intake process. Ours can be a model for other clinics.
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Affiliation(s)
- Jaron Smith
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona.
| | - Paul Broker
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Melony Chakrabarty
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Jason Santiago
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Jennifer Farabaugh
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Janice Piatt
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Kristen Samaddar
- Division of Primary Care, Complex-Care, and Adolescent Medicine, Phoenix Children's Hospital, Phoenix, Arizona
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Implementation strategies in emergency management of children: A scoping review. PLoS One 2021; 16:e0248826. [PMID: 33761525 PMCID: PMC7990517 DOI: 10.1371/journal.pone.0248826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 03/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Implementation strategies are vital for the uptake of evidence to improve health, healthcare delivery, and decision-making. Medical or mental emergencies may be life-threatening, especially in children, due to their unique physiological needs when presenting in the emergency departments (EDs). Thus, practice change in EDs attending to children requires evidence-informed considerations regarding the best approaches to implementing research evidence. We aimed to identify and map the characteristics of implementation strategies used in the emergency management of children. METHODS We conducted a scoping review using Arksey and O'Malley's framework. We searched four databases [Medline (Ovid), Embase (Ovid), Cochrane Central (Wiley) and CINAHL (Ebsco)] from inception to May 2019, for implementation studies in children (≤21 years) in emergency settings. Two pairs of reviewers independently selected studies for inclusion and extracted the data. We performed a descriptive analysis of the included studies. RESULTS We included 87 studies from a total of 9,607 retrieved citations. Most of the studies were before and after study design (n = 68, 61%) conducted in North America (n = 63, 70%); less than one-tenth of the included studies (n = 7, 8%) were randomized controlled trials (RCTs). About one-third of the included studies used a single strategy to improve the uptake of research evidence. Dissemination strategies were more commonly utilized (n = 77, 89%) compared to other implementation strategies; process (n = 47, 54%), integration (n = 49, 56%), and capacity building and scale-up strategies (n = 13, 15%). Studies that adopted capacity building and scale-up as part of the strategies were most effective (100%) compared to dissemination (90%), process (88%) and integration (85%). CONCLUSIONS Studies on implementation strategies in emergency management of children have mostly been non-randomized studies. This review suggests that 'dissemination' is the most common strategy used, and 'capacity building and scale-up' are the most effective strategies. Higher-quality evidence from randomized-controlled trials is needed to accurately assess the effectiveness of implementation strategies in emergency management of children.
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Gutman CK, Duda E, Newton N, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Simon HK, Camacho‐Gonzalez A, Morris CR. Unique Needs for the Implementation of Emergency Department Human Immunodeficiency Virus Screening in Adolescents. Acad Emerg Med 2020; 27:984-994. [PMID: 32717124 DOI: 10.1111/acem.14095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/13/2020] [Accepted: 07/19/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The Centers for Disease Control and Prevention (CDC) recommend universal human immunodeficiency virus (HIV) screening starting at 13 years, which has been implemented in many general U.S. emergency departments (EDs) but infrequently in pediatric EDs. We aimed to 1) implement a pilot of routine adolescent HIV screening in a pediatric ED and 2) determine the unique barriers to CDC-recommended screening in this region of high HIV prevalence. METHODS This was a prospective 4-month implementation of a routine HIV screening pilot in a convenience sample of adolescents 13 to 18 years at a single pediatric ED, based on study personnel availability. Serum-based fourth-generation HIV testing was run through a central laboratory. Parents were allowed to remain in the room for HIV counseling and testing. Data were collected regarding patient characteristics and HIV testing quality metrics. Comparisons were made using chi-square and Fisher's exact tests. Regression analysis was performed to assess for an association between parent presence at the time of enrollment and adolescent decision to participate in HIV screening. RESULTS Over 4 months, 344 of 806 adolescents approached consented to HIV screening (57% female, mean ± SD = 15.1 ± 1.6 years). Adolescents with HIV screening were more likely to be older than those who declined (p = 0.025). Other blood tests were collected with the HIV sample for 21% of adolescents; mean time to result was 105 minutes (interquartile range = 69 to 123) and 79% were discharged before the result was available. Having a parent present for enrollment was not associated with adolescent participation (adjusted odds ratio = 1.07, 95% CI = 0.67 to 1.70). Barriers to testing included: fear of needlestick, time to results, cost, and staff availability. One of 344 tests was positive in a young adolescent with Stage 1 HIV. CONCLUSIONS Routine HIV screening in adolescents was able to be implemented in this pediatric ED and led to the identification of early infection in a young adolescent who would have otherwise been undetected at this stage of disease. Addressing the unique barriers to adolescent HIV screening is critical in high-prevalence regions and may lead to earlier diagnosis and treatment in this vulnerable population.
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Affiliation(s)
- Colleen K. Gutman
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
| | - Elizabeth Duda
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Naomi Newton
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Ryan Alevy
- Morehouse School of Medicine Atlanta GAUSA
| | - Katherine Palmer
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Martha Wetzel
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Janet Figueroa
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
| | - Mark Griffiths
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Atsuko Koyama
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Lauren Middlebrooks
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Harold K. Simon
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
| | - Andres Camacho‐Gonzalez
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Grady Infectious Disease Program Ponce Family and Youth ClinicGrady Health Systems Atlanta GAUSA
| | - Claudia R. Morris
- From the Department of Pediatrics Emory University School of Medicine Atlanta GAUSA
- Children's Healthcare of Atlanta Atlanta GAUSA
- and the Department of Emergency Medicine Emory University School of Medicine Atlanta GAUSA
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8
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Gutman CK, Middlebrooks L, Camacho-Gonzalez A, Shah B, Belay Z, Morris CR. Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department. AIDS Patient Care STDS 2020; 34:373-379. [PMID: 32799540 PMCID: PMC7480725 DOI: 10.1089/apc.2020.0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.
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Affiliation(s)
- Colleen K. Gutman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lauren Middlebrooks
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andres Camacho-Gonzalez
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Division of Pediatric Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bijal Shah
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Zena Belay
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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Gattu RK, Paik G, Wang Y, Ray P, Lichenstein R, Black MM. The Hunger Vital Sign Identifies Household Food Insecurity among Children in Emergency Departments and Primary Care. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E107. [PMID: 31581751 PMCID: PMC6827017 DOI: 10.3390/children6100107] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 11/16/2022]
Abstract
This study aimed: (1) to examine the sensitivity and specificity of the 2-item Hunger Vital Sign against the 18-item Household Food Security Survey Module (HFSSM) in identifying young children in food insecure households in emergency department and primary care sites and (2) to examine associations between food insecurity and adverse health conditions. We conducted cross-sectional surveys from 2009-2017 among 5039 caregivers of children age <48 months. We measured adverse child health by caregiver-reported perceived health, prior hospitalizations, and developmental risk (Parents' Evaluation of Developmental Status). Analyses were conducted using covariate-adjusted logistic regression. Sensitivity and specificity of the Hunger Vital Sign against the HFSSM were 96.7% and 86.2%. Using the HFSSM, children in the emergency department had a 28% increase in the odds of experiencing food insecurity, compared to children in primary care, aOR = 1.28, 95% Confidence Interval (CI) = 1.08-1.52, p = 0.005. Using the Hunger Vital Sign, the increase was 26%, aOR = 1.26, 95% CI = 1.08-1.46, and p = 0.003. The odds of children's adverse health conditions were significantly greater in food insecure households, compared to food secure households, using either HFSSM or the Hunger Vital Sign. Screening for food insecurity with the Hunger Vital Sign identifies children at risk for adverse health conditions in both primary care and emergency department sites, and can be used to connect families with resources to alleviate food insecurity.
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Affiliation(s)
- Rajender K Gattu
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Grace Paik
- Division of Growth & Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Yan Wang
- Division of Growth & Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Prema Ray
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Richard Lichenstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
| | - Maureen M Black
- Division of Growth & Nutrition, Department of Pediatrics, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
- RTI International, Research Triangle Park, NC 27709, USA.
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Bhalakia AM, Talib HJ, Choi J, Watnick D, Bochner R, Futterman D, Gross E. Acceptance of Routine HIV Testing by Hospitalized Adolescents and Young Adults. Hosp Pediatr 2018; 8:187-193. [PMID: 29599198 PMCID: PMC5869342 DOI: 10.1542/hpeds.2017-0194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Youth carry a disproportionate burden of new HIV infections. With our study, we aimed to characterize HIV testing experiences among adolescents and young adults admitted to a children's hospital that is located in a high HIV-prevalent community and implemented routine HIV testing for all patients ≥13 years of age. METHODS A total of 120 patients aged 13 to 24 years old who were admitted to our hospital and had a documented offer of routine HIV testing on admission were invited to complete a self-administered survey that asked about sex, race and/or ethnicity, HIV risk behaviors, and attitudes toward routine HIV testing in the hospital. Date of birth, admission diagnosis, and verification of HIV testing and results were collected by chart review. RESULTS Study participants (N = 99) were 17.4 ± 2.3 years old, 52% female, 47% Hispanic, and 29% African American. Additional characteristics include the following: 65% had previous sexual activity, 11% had a history of sexually transmitted infections, and 12% were worried about their risk for HIV. Forty-seven percent of participants accepted HIV testing, with older patients (P < .01) and those reporting previous sexual activity (P < .01) and a previous HIV test (P < .01) being more likely to accept testing. A total of 96% of participants agreed that the hospital is a good place to offer HIV testing. CONCLUSIONS Our findings support offering routine HIV testing to youth admitted to children's hospital. Given the high incidence of new and undiagnosed HIV infections among youth, additional venues for HIV testing are essential.
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Affiliation(s)
- Avni M Bhalakia
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas;
| | - Hina J Talib
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Jaeun Choi
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York; and
| | - Dana Watnick
- Center for AIDS Research, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York
| | - Risa Bochner
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Donna Futterman
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
| | - Elissa Gross
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York
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Chávez PRG, Wesolowski LG, Peters PJ, Johnson CH, Nasrullah M, Oraka E, August EM, DiNenno E. How well are U.S. primary care providers assessing whether their male patients have male sex partners? Prev Med 2018; 107:75-80. [PMID: 29126916 PMCID: PMC5807188 DOI: 10.1016/j.ypmed.2017.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 11/17/2022]
Abstract
Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and related HIV-risk factors. We analyzed data from a panel-derived web-based survey for healthcare providers conducted in 2014 to describe how PCPs in the U.S. determined their patients' MSM status. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status (i.e., PCP used "a patient-completed questionnaire" or "routine verbal review of sex history"). Among the 1008 PCPs, 56% determined MSM status by routine verbal review of sexual history; 41% by patient disclosure; 39% by questions driven by symptoms/history; 23% by using a patient-completed questionnaire, and 9% didn't determine MSM status. PCPs who systematically determined MSM status (n=665; 66%) were more likely to be female (aPR=1.16, CI=1.06-1.26), to be affiliated with a teaching hospital (aPR=1.15, CI=1.06-1.25), to routinely screen all patients aged 13-64 for HIV (aPR=1.29, CI=1.18-1.41), and to estimate that 6% or more of their male patients are MSM (aPR=1.14, CI=1.01-1.30). The majority of PCPs assessed MSM status and HIV risk factors through routine verbal reviews of sexual history. Implementing a systematic approach to identify MSM status and assess risk may allow PCPs to identify more patients needing frequent HIV testing and other preventive services, while mitigating socio-cultural barriers to obtaining such information.
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Affiliation(s)
- Pollyanna R G Chávez
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Laura G Wesolowski
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Philip J Peters
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Christopher H Johnson
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Muazzam Nasrullah
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Emeka Oraka
- ICF International at Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Euna M August
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
| | - Elizabeth DiNenno
- Centers for Disease Control and Prevention, National Center for HIV, Hepatitis, STD and TB Prevention, Division of HIV/AIDS Prevention, 1600 Clifton Road NE, Atlanta, GA 30333, USA.
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Heinert S, Carter J, Mauntel-Medici C, Lin J. Assessment of Nurse Perspectives on an Emergency Department-Based Routine Opt-Out HIV Screening Program. J Assoc Nurses AIDS Care 2016; 28:316-326. [PMID: 28087204 DOI: 10.1016/j.jana.2016.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 12/07/2016] [Indexed: 11/15/2022]
Abstract
Routine opt-out HIV screening is recommended for everyone between 13 and 64 years of age. An urban, academic emergency department implemented a nurse-driven routine opt-out HIV screening program. The aim of our study was to assess program uptake and opportunities to improve the program from the perspectives of emergency nurses. Emergency nurses completed a brief prediscussion questionnaire and then participated in a focus group or semi-structured one-on-one interview to elicit feedback on the routine opt-out HIV screening program. All 16 participants felt adequately prepared for the screening program. Several themes emerged from the discussions, including challenges of specific patient characteristics and overall nurse and patient support for the program. One thread across themes was the importance of good language and communication skills in such programs. While there are opportunities to improve nurse-driven routine opt-out HIV testing programs in emergency settings, this program was found to be accepted by emergency nurses.
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Schackman BR, Eggman AA, Leff JA, Braunlin M, Felsen UR, Fitzpatrick L, Telzak EE, El-Sadr W, Branson BM. Costs of Expanded Rapid HIV Testing in Four Emergency Departments. Public Health Rep 2016; 131 Suppl 1:71-81. [PMID: 26862232 DOI: 10.1177/00333549161310s109] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The HIV Prevention Trials Network (HPTN) 065 trial sought to expand HIV screening of emergency department (ED) patients in Bronx, New York, and Washington, D.C. This study assessed the testing costs associated with different expansion processes and compared them with costs of a hypothetical optimized process. METHODS Micro-costing studies were conducted in two participating EDs in each city that switched from point-of-care (POC) to rapid-result laboratory testing. In three EDs, laboratory HIV testing was only conducted for patients having blood drawn for clinical reasons; in the other ED, all HIV testing was conducted with laboratory testing. Costs were estimated through direct observation and interviews to document process flows, time estimates, and labor and materials costs. A hypothetical optimized process flow used minimum time estimates for each process step. National wage and fringe rates and local reagent costs were used to determine the average cost (excluding overhead) per completed nonreactive and reactive test in 2013 U.S. dollars. RESULTS Laboratory HIV testing costs in the EDs ranged from $17.00 to $23.83 per completed nonreactive test, and POC testing costs ranged from $17.64 to $37.60; cost per completed reactive test ranged from $89.29 to $123.17. Costs of hypothetical optimized HIV testing with automated process steps were approximately 45% lower for nonreactive tests and 20% lower for reactive tests. The cost per ED visit to conduct expanded HIV testing in each hospital ranged from $1.21 to $3.96. CONCLUSION An optimized process could achieve additional cost savings but would require an investment in electronic system interfaces to further automate testing processes.
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Affiliation(s)
- Bruce R Schackman
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY
| | - Ashley A Eggman
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY
| | - Jared A Leff
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY
| | - Megan Braunlin
- Weill Cornell Medical College, Department of Healthcare Policy and Research, New York, NY
| | - Uriel R Felsen
- Montefiore Medical Center, Division of Infectious Diseases, Bronx, NY
| | | | | | - Wafaa El-Sadr
- Columbia University, Mailman School of Public Health, International Center for AIDS Care and Treatment Programs, New York, NY
| | - Bernard M Branson
- Centers for Disease Control and Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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Adolescent With Weight Loss and Abdominal Pain. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2016. [DOI: 10.1016/j.cpem.2016.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Mehta AS, Goyal MK, Dowshen N, Mistry RD. Practices, Beliefs, and Perceived Barriers to Adolescent Human Immunodeficiency Virus Screening in the Emergency Department. Pediatr Emerg Care 2015; 31:621-6. [PMID: 25834965 DOI: 10.1097/pec.0000000000000370] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Limited data exist regarding knowledge of and compliance to the Centers for Disease Control and Prevention's universal adolescent human immunodeficiency virus (HIV) screening recommendations. Our objective was to assess current guideline knowledge, practice, and perceived barriers to emergency department (ED)-based adolescent HIV screening. METHODS We administered an anonymous Web-based cross-sectional survey from May 1, 2012, to June 30, 2012, to 1073 physicians from the American Academy of Pediatrics Section on Emergency Medicine LISTSERV. Survey participants were included if they (1) practiced as attending-level physicians, (2) practiced primarily in pediatric emergency medicine or general emergency medicine, and (3) provided clinical care for patients younger than the age of 21 years. The survey examined respondent demographics, knowledge, attitudes, beliefs, practices, and barriers to ED-based HIV screening. Standard descriptive statistics and comparative analyses were performed. RESULTS A total of 220 responses were obtained; 29 responses were excluded and 191 responses were included in the study. Most of the participants were from urban, free-standing children's hospitals and had an annual ED volume of more than 61,000 patient visits. Respondent knowledge of the Centers for Disease Control and Prevention guidelines was low; less than 40% of the respondents identified correct consent requirements. Only 15.4% of the respondents reported screening for HIV more than 10 times for the prior 6 months. Most frequently cited barriers included concerns for privacy (67.4%), follow-up (67%), and cost-effectiveness (65.4%). Human immunodeficiency virus screening facilitators included availability of health educators (83%), established follow-up (74.7%), and rapid HIV tests (65.2%). CONCLUSIONS Emergency department clinicians exhibit poor knowledge of adolescent HIV screening recommendations. Current universal screening practices remain low; barriers to screening are numerous. Future efforts should disseminate guideline knowledge, increase rapid HIV testing and health educator availability, as well as reduce adolescent-specific barriers.
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Affiliation(s)
- Avani S Mehta
- From the *Division of Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; †Emergency Medicine and Trauma Services, Children's National Medical Center, Washington, DC; ‡Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA; and §Section of Emergency Medicine, Children's Hospital Colorado, Aurora, CO
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Leblanc J, Burnet E, D'Almeida KW, Lert F, Simon T, Crémieux AC. The role of nurses in HIV screening in health care facilities: A systematic review. Int J Nurs Stud 2015; 52:1495-513. [PMID: 25979185 DOI: 10.1016/j.ijnurstu.2015.04.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 03/26/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine nurse-driven HIV screening in various health care settings in terms of its impact on test offering, acceptance and delivery rates, nursing responsibilities, staff perceptions and long-term implementation. DESIGN Systematic review. REVIEW METHODS The systematic review conducted in September 2014 adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Two independent reviewers extracted and summarised the eligible studies using a standardised form. STUDY ELIGIBILITY CRITERIA All studies published from 2004 to 2014 that explored nurse-driven HIV screening practice in health care facilities in countries with comparable concentrated HIV epidemics were included. DATA SOURCES MEDLINE, EBSCO CINAHL. RESULTS Overall, 30 quantitative, qualitative and mixed methods studies fulfilled the eligibility criteria. The studies showed a trend in higher test offering, better acceptance and higher delivery rates with the implementation of nurse-driven HIV screening. However, among the 23 studies (77%) that evaluated these aims, only 13 studies (56%) had a control group, and 4 studies (17%) were randomised controlled trials (RCT) in few centres (i.e., 1 or 2). In 2 studies that compared nurse-driven HIV test offering to physician intervention, the participation of nurses was higher than that of physicians (85% vs. 54%, p<0.001; 47% vs. 28%, p<0.05). In a third study, the intervention of a dedicated nurse increased the test offering from 96.5% to 99.5% (OR=7.27, 95% CI=1.02-316.9). Acceptance rates increased with the nurse intervention in 2 RCTs (75% vs. 71%, p=0.025; 45% vs. 19%, p<0.05) and in a cohort study (74.8% vs. 84.3%, OR=1.82, 95% CI=1.14-2.88), whereas it decreased in 2 other studies. The testing rates increased in 7 out of 10 studies, with a maximum absolute increase of 65.9%. Nurse-driven HIV screening was evaluated at the time of routine HIV screening implementation in 27 studies (90%) and provided nurses with new responsibilities in 9 studies (30%). The few studies (23%) that explored how health care professionals, including nurses, perceived the strategy showed that this approach was well received. However, several operational barriers, such as lack of time, prevented its long-term implementation. CONCLUSION The review supports the implementation of nurse-driven HIV screening. However, the evaluation of the impact of the nurse approach by RCTs was scarce, calling for additional research to better evaluate the impact of the nursing profession's contribution to HIV screening. Moreover, the perceptions of nurses and health care staff were seldom evaluated and require further exploration to improve nurse-driven HIV screening implementation.
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Affiliation(s)
- Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien, Clinical Research Center of East of Paris (CRC-Est), 184, rue du Faubourg Saint Antoine, 75012 Paris, France; Doctoral School of Public Health 420, Versailles Saint-Quentin University, Versailles, France; EA 3647, Versailles Saint-Quentin University, Versailles, France.
| | - Espérie Burnet
- AP-HP, Groupe Hospitalier des Hôpitaux Universitaires Centre Parisien, Paris, France.
| | | | - France Lert
- Epidemiology and Population Health Research Center, Team 11 Inserm U1018, Villejuif, France.
| | - Tabassome Simon
- AP-HP, Hôpital St Antoine, Department of Clinical Pharmacology, Clinical Research Center of East of Paris (CRC-Est), Paris, France; INSERM U-698, Paris, France; University Pierre et Marie Curie, Paris 6, Paris, France.
| | - Anne-Claude Crémieux
- AP-HP, Hôpital Raymond-Poincaré, Infectious disease department, Garches, France; EA 3647, Versailles Saint-Quentin University, Versailles, France.
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Eckerle MD, Namde M, Holland CK, Ruffner AH, Hart KW, Lindsell CJ, Reed JL, Lyons MS. Opportunities for earlier HIV diagnosis in a pediatric ED. Am J Emerg Med 2015; 33:917-9. [PMID: 26008582 DOI: 10.1016/j.ajem.2015.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 04/02/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES Emergency department (ED) HIV screening is recommended but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV. METHODS This retrospective cohort study reviewed PED records of a group of young adults receiving HIV care in an urban hospital setting. Pediatric ED visits were selected for review if they took place after the patient's estimated time of HIV acquisition and before their eventual diagnosis. Charts were reviewed to determine whether HIV infection was suspected and whether testing was offered. RESULTS Among a cohort of HIV-positive young adults, only 3 (3.6%; 95% confidence interval, 0.9-10.8) of 84 were seen in the PED during the time they were undiagnosed but likely to be infected with HIV. Among these subjects, there was no documentation that HIV testing was offered or refused nor was there documented suspicion of HIV. CONCLUSIONS There are opportunities for earlier diagnosis of HIV in PEDs, affirming the importance of HIV screening implementation in these settings. However, PEDs are unlikely to have the same frequency of contact with undiagnosed individuals as do adult EDs. Alternative methods of accessing at-risk adolescent populations must be identified.
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Affiliation(s)
- Michelle D Eckerle
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Madjimbaye Namde
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Carolyn K Holland
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Andrew H Ruffner
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Kim W Hart
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christopher J Lindsell
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
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HIV testing experience in New York City: offer of and willingness to test in the context of new legal support of routine testing. J Acquir Immune Defic Syndr 2015; 68 Suppl 1:S45-53. [PMID: 25545493 DOI: 10.1097/qai.0000000000000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, routine HIV testing is recommended for persons aged 13-64 years. In 2010, New York State passed a law mandating offer of testing in most health-care settings. We report on the consumer perspective in New York City (NYC) shortly after the law's enactment. METHODS We analyzed data from a 2011 telephone survey representative of NYC adults aged 18-64 years (n = 1,846). This analysis focused on respondents' report of HIV test offer at last clinical visit and of willingness to test if recommended by their doctor. Offer and willingness were estimated by age, gender, race/ethnicity, education, income, marital status, sexual identity, partner number, and HIV testing history; associations were examined using multivariable regression. RESULTS Among NYC adults, 35.7% reported an HIV test in the past year and 31.8% had never tested. Among 86.7% with a clinical visit in the past year, 31.4% reported being offered a test at last visit. Offer was associated with younger age, race/ethnicity other than white, non-Hispanic, lower income, and previous testing. Only 6.7% of never-testers were offered a test at last clinical visit. Willingness to test if recommended was high overall (90.2%) and across factors examined. CONCLUSIONS After a new law was enacted in support of routine HIV testing, approximately 1 in 3 New Yorkers aged 18-64 years were offered a test at last clinical visit; 9 in 10 were willing to test if recommended by their doctor. This suggests that patient attitudes will not be a barrier to complete implementation of the law.
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Haukoos JS, Lyons MS, White DAE, Hsieh YH, Rothman RE. Acute HIV infection and implications of fourth-generation HIV screening in emergency departments. Ann Emerg Med 2014; 64:547-51. [PMID: 25128010 DOI: 10.1016/j.annemergmed.2014.07.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 06/28/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Jason S Haukoos
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, the Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, and the Department of Epidemiology, Colorado School of Public Health, Aurora, CO.
| | - Michael S Lyons
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Douglas A E White
- Department of Emergency Medicine, Alameda Health System, Oakland, CA
| | - Yu-Hsiang Hsieh
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD
| | - Richard E Rothman
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD
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Jebrail MJ, Sinha A, Vellucci S, Renzi RF, Ambriz C, Gondhalekar C, Schoeniger JS, Patel KD, Branda SS. World-to-Digital-Microfluidic Interface Enabling Extraction and Purification of RNA from Human Whole Blood. Anal Chem 2014; 86:3856-62. [DOI: 10.1021/ac404085p] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Mais J. Jebrail
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Anupama Sinha
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Samantha Vellucci
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Ronald F. Renzi
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Cesar Ambriz
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Carmen Gondhalekar
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Joseph S. Schoeniger
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Kamlesh D. Patel
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
| | - Steven S. Branda
- Departments of Biotechnology and Bioengineering, ‡Systems Biology, and §Advanced Systems Engineering and
Deployment, Sandia National Laboratories, Livermore, California, United States
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Rakhmanina N, Messenger N, Phillips G, Teach S, Morrison S, Hern J, Payne J, Ganesan K, Castel AD. Factors affecting acceptance of routine human immunodeficiency virus screening by adolescents in pediatric emergency departments. J Adolesc Health 2014; 54:176-82. [PMID: 24060572 DOI: 10.1016/j.jadohealth.2013.07.027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/26/2013] [Accepted: 07/26/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Human immunodeficiency virus (HIV) screening in health care settings including emergency departments (EDs) is recommended for adolescents in the United States. This study aimed to evaluate the acceptance of and the factors affecting the HIV screening in pediatric EDs. METHODS A prospective, cross-sectional study of rapid opt-out oral HIV screening among adolescents ≥13 years of age was conducted in two pediatric EDs during 2009-2011. Descriptive statistics and logistic regression models were used to identify factors associated with the acceptance of HIV screening. RESULTS During 24 months, 8,519 adolescents were approached for HIV screening; 6,184 (72.6%) did not opt out, and of those 5,764 (93.2%) were tested for HIV. Most adolescents who accepted testing were black (80.5%), female (57.6%), aged 15-17 years (50.1%), and District of Columbia residents (67.7%), and were accompanied by a guardian (69.1%). Acceptance of HIV screening varied by age, race/ethnicity, and state of residence, with younger (<15 years) (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.33-2.09), non-black adolescents (aOR, .88; 95% CI, .77-.99) and non-District of Columbia residents (aOR, .86; 95% CI, .77-.96) being more likely to opt out of testing. Lower odds of opt-out of HIV testing were seen among adolescents with a guardian present (aOR, .42; 95% CI, .34-.53). The reasons for opt-out varied significantly by age and the presence of a guardian. CONCLUSIONS The patient's age and the presence of a guardian were significantly associated with adolescents' decision and reasons to opt out of HIV screening in pediatric EDs. Further studies are necessary to evaluate the interventions needed to increase routine ED HIV screening in adolescents.
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Affiliation(s)
- Natella Rakhmanina
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.
| | - Nicole Messenger
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Gregory Phillips
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC
| | - Stephen Teach
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Division of Allergy and Immunology, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Sephora Morrison
- Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Jaclyn Hern
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Jun Payne
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Kavitha Ganesan
- Center for Translational Science, Children's Research Institute, Washington, DC
| | - Amanda D Castel
- Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC
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