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Gutman CK, Koyama A, Pickett M, Holmstrom S, Ahmad FA, Hoch A, Lehto E, Schneider K, Stukus KS, Weber E, Stich C, Chernick LS. Pediatric Emergency Physicians' Knowledge, Attitudes, and Behaviors Regarding Confidential Adolescent Care. Pediatr Emerg Care 2024; 40:e94-e104. [PMID: 38355126 DOI: 10.1097/pec.0000000000003130] [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: 02/16/2024]
Abstract
OBJECTIVES More than 19 million adolescents seek care in the emergency department (ED) annually. We aimed to describe the knowledge, attitudes, and behaviors related to confidential adolescent care among pediatric ED physicians. METHODS We conducted a cross-sectional questionnaire of US physician members of the Pediatric Emergency Medicine Collaborative Research Committee survey listserv. The 24-item questionnaire assessed familiarity with adolescent confidentiality laws, attitudes toward providing confidential care, frequency of discussing behavioral health topics confidentially, and factors influencing the decision to provide confidential care. We dichotomized Likert responses and used χ 2 to compare subgroups. RESULTS Of 476 eligible physicians, 151 (32%) participated. Most (91. 4%) had completed pediatric emergency medicine fellowship. More participants reported familiarity with all sexual health-related laws compared with all mental health-related laws (64% vs 49%, P < 0.001). The median age at which participants thought it was important to begin routinely providing confidential care was 12 years; 9% thought confidential interviews should not be routinely conducted until older adolescence or at all. Their decision to provide confidential care was influenced by the following: chief complaint (97%), time (43%), language (24%), presence of family (23%) or friends (14%), and space (22%). CONCLUSIONS Respondents reported moderate familiarity with adolescent confidentiality laws. Although they viewed confidential care as something they were comfortable providing, the likelihood of doing so varied. Barriers to confidential care were influenced by their assessment of adolescents' behavioral health risk, which may contribute to health inequity. Future efforts are needed to develop strategies that augment confidential ED care for adolescents.
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Affiliation(s)
| | - Atsuko Koyama
- Department of Child Health, University of Arizona, College of Medicine, Phoenix, AZ
| | - Michelle Pickett
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ariel Hoch
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Boston University School of Medicine, Boston, MA
| | - Elizabeth Lehto
- Department of Pediatric Emergency Medicine, Norton Children's and University of Louisville School of Medicine, Louisville, KY
| | - Kari Schneider
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Kristin S Stukus
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University College of Medicine, Columbus, OH
| | - Emily Weber
- Division of Pediatrics, Department of Emergency Medicine, SUNY Downstate Medical Center/Kings County Hospital Center, Brooklyn, NY
| | - Cassandra Stich
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL
| | - Lauren S Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY
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Miller MK, Goggin K, Stancil SL, Miller E, Ketterer T, Staggs V, McNeill-Johnson AD, Adams A, Mollen CJ. Feasibility of adolescent contraceptive care in the pediatric emergency department: A pilot randomized controlled trial. Acad Emerg Med 2024. [PMID: 38881403 DOI: 10.1111/acem.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 05/10/2024] [Accepted: 05/23/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND This study assessed feasibility constructs of adolescent contraceptive care in the pediatric emergency department (PED), including contraception initiation. METHODS We conducted a randomized trial in two PEDs with pregnancy-capable adolescents aged 15-18 years who were assigned to enhanced usual care (usual) or same-day initiation (same day). All received counseling and clinic referral, but same-day participants could also receive contraception in the PED. We trained PED clinicians in counseling and prescribing. Adolescents and clinicians rated feasibility using five Likert-type items (1 = strongly disagree to 5 = strongly agree) after the session. We assessed PED medication initiation and appropriateness via medical record review and contraception use and side effects at 30 days via adolescent survey. To further explore feasibility, we conducted clinician interviews at study completion; these were audio-recorded, transcribed, and analyzed. We hypothesized contraceptive care would be feasible (defined as average score ≥ 4 across five survey items). RESULTS We enrolled 37 adolescents (12 in usual and 25 in same-day), mean age was 16.6 years, 73% were Black, and 19% were Hispanic. We trained 27 clinicians. Average feasibility scores were 4.6 ± 0.4 (adolescents) and 4.1 ± 0.8 (clinicians). Eleven (44%) same-day participants initiated contraception in the PED. One adolescent with migraines initially received estrogen-containing pills; this was corrected after discharge. At 30 days, same-day participants were more likely to report contraception use (78% vs. 13%; p = 0.007). One adolescent reported bloating as a side effect. Clinicians enjoyed delivering contraceptive care, found study resource materials useful, and identified staffing shortages as a barrier to care delivery. CONCLUSIONS We are among the first to report on PED-based adolescent contraception initiation to prevent unintended pregnancy. Adolescents and clinicians reported that contraceptive care was feasible. Initiation was common and medications were largely appropriate and tolerated. Future efforts should explore integrating contraceptive care into routine PED care.
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Affiliation(s)
- Melissa K Miller
- Department of Pediatrics, Division of Emergency Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Kathy Goggin
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, Division of Health Services of Outcomes Research Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- University of Missouri School of Pharmacy, Kansas City, Missouri, USA
| | - Stephani L Stancil
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
- Department of Pediatrics, Division of Adolescent Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
| | - Elizabeth Miller
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine, University of Pittsburgh Medical Center-Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Public Health and Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Tara Ketterer
- Policy Lab, Roberts Center for Pediatric Research-Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Vince Staggs
- Department of Pediatrics, Division of Health Services of Outcomes Research Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- IDDI Inc., Raleigh, North Carolina, USA
| | - April D McNeill-Johnson
- Department of Pediatrics, Division of Emergency Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
- Department of Pediatrics, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Amber Adams
- Department of Pediatrics, Division of Emergency Medicine, Children's Mercy Hospital and Clinics, Kansas City, Missouri, USA
- Vibrant Health, Kansas City, Missouri, USA
| | - Cynthia J Mollen
- Department of Pediatrics, Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Perelman School of Medicine-University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Ibitoye M, Bennett AS, Jarlais DCD, Bugaighis M, Chernick LS, Aronson ID. "I Didn't Know What They're Gonna Do to Me: So That's Why I Said No": Why Youth Decline HIV Testing in Emergency Departments. Behav Med 2024; 50:47-54. [PMID: 35904104 PMCID: PMC9884312 DOI: 10.1080/08964289.2022.2100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/06/2022] [Indexed: 01/31/2023]
Abstract
Youth between the ages of 13 and 24 account for over 20% of new HIV diagnoses in the United States but are the least likely age group to be HIV tested in healthcare settings including the emergency department. This is in part due to the fact that almost 50% of youth decline testing when offered. We elucidated youth patients' perspectives on barriers to and facilitators of routine HIV testing of youth in an urban emergency department setting. Thirty-seven patients aged 13-24 years were recruited from the pediatric and adult emergency departments at a high-volume hospital in New York City from August 2019 to March 2020. Semi-structured in-depth interviews were conducted with all participants. Interviews were audio-recorded and transcribed verbatim, and transcripts were coded using an inductive thematic analysis approach. Youths' main reasons for declining HIV testing when offered included low risk perception, privacy concerns, HIV-related stigma, and low levels of HIV-related knowledge. Participants' responses suggested that HIV educational materials provided when testing is offered may be insufficient. Participants recommended providing additional HIV education and better incorporating HIV testing into the emergency department routine to increase testing among youth. Efforts are needed to help youth recognize their own HIV risk and increase their HIV-related knowledge. This may be accomplished by providing youth with additional educational materials on HIV, possibly via tablet-based interventions or other methods that may enhance privacy, combined with discussions with healthcare providers. Such efforts may help increase HIV testing acceptance among youth seen in the emergency department.
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Affiliation(s)
- Mobolaji Ibitoye
- Digital Health Empowerment, Brooklyn, NY, USA
- Institute for Population Research, The Ohio State University, Columbus, OH, USA
| | - Alex S. Bennett
- Digital Health Empowerment, Brooklyn, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
| | - Don C. Des Jarlais
- Department of Epidemiology, School of Global Public Health, New York University, New York, NY, USA
| | - Mona Bugaighis
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Lauren S. Chernick
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Ian D. Aronson
- Digital Health Empowerment, Brooklyn, NY, USA
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, NY, USA
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Choi YJ, Lee SH, Yi J, Nho WY. Emergency contraceptive provision in the emergency department and risk analysis for delayed utilization in South Korea. Medicine (Baltimore) 2023; 102:e36195. [PMID: 38013329 PMCID: PMC10681593 DOI: 10.1097/md.0000000000036195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/27/2023] [Indexed: 11/29/2023] Open
Abstract
In certain nations, the emergency department (ED) has been designated as the primary center to provide emergency contraception (EC). However, analyses of ED visits for EC are limited. Moreover, ED-based research that focuses on time is limited to only a few surveys. The aims of this study were to examine the characteristics of ED visitors for EC and the interval between the coitus and arrival at the ED, and to analyze the factors associated with delays in visiting the ED. This retrospective cohort study involved patients at 2 urban tertiary academic hospitals in South Korea. All patients who presented to the ED for EC between January 2019 and December 2021 were analyzed. The median age of the participants was 26 years. The most common variables were age of 20 to 29 years (42.0%), evening visits (34.9%), weekends or public holidays (62.6%), single status (89.2%), and visits after contraceptive failure (79.1%). The mean time interval was 7.49 hours, and 77.4% of all patients visited the ED within 12 hours. Patients who received public sex education presented earlier (P < .001). ED visits after nonconsensual sexual incidents represented significantly delayed presentations (P < .001). Regression analysis revealed that both the lack of public education and the occurrence of nonconsensual coitus were associated with incident-to-ED visit intervals of >12 hours. Most patients received emergency contraceptive pill (ECP) within the recommended timeframe. In particular, nationwide school-based public sex education positively affected early ECP access. In contrast, ECP provision was delayed for patients who experienced nonconsensual coitus. Strategies for timely ECP access should account for possible concerns about stigmatization and privacy.
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Affiliation(s)
- Yoon Jung Choi
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
| | - Soo Hyung Lee
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
- Department of Emergency Medicine, School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Jeongsik Yi
- Department of Emergency Medicine, CHA Gumi Medical Center, Gumi, Republic of Korea
- Department of Emergency Medicine, School of Medicine, CHA University, Pocheon, Republic of Korea
| | - Woo Young Nho
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
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Nguyen DT, Boyle MD, Badolato GM, Goyal MK. Sexually transmitted infections and treatment adherence among adolescents in the emergency department: A mobile health pilot intervention. Acad Emerg Med 2023; 30:773-775. [PMID: 36606504 DOI: 10.1111/acem.14656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/11/2022] [Accepted: 12/26/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Dalena T Nguyen
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Meleah D Boyle
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Gia M Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, DC, USA
- Departments of Pediatrics and Emergency Medicine, George Washington University Hospital, Washington, DC, USA
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Kerolle S, Zuckerbraun N, Reed J, Pollack A, Lieberman J, Ruppert K, Hoehn E. Examining Parental Acceptance of Confidential Contraception Initiation in a Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:125-129. [PMID: 35947074 DOI: 10.1097/pec.0000000000002818] [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
BACKGROUND The pediatric emergency department (PED) is a valuable site for contraceptive services among adolescents at risk for pregnancy. Studies have shown that adolescents are interested in such services; however, little is known about parental opinions on contraceptive care in the PED. We aimed to (1) assess parental acceptance of confidential provisions of contraception in the PED and (2) identify facilitators/barriers to parental acceptance of contraception in this setting. METHODS This study included parents/guardians of females aged 14 to 19 years who presented to the PED with any chief complaint. Participants completed a self-administered 25-question survey based on previously validated questions to assess their acceptance of contraception provisions, both confidentially and with parental involvement, for their adolescent in the PED. χ 2 or Fisher exact tests were used to examine variables associated with parental acceptance of confidential contraception. RESULTS Of the 102 parents/guardians surveyed, most parents (58/102, 57%) were accepting of confidential contraception for their adolescent. However, more parents (82/101, 81%) were accepting of contraception in the ED with their involvement, as opposed to confidentially without their involvement. Those accepting had an increased perceived risk of their adolescent having sex or becoming pregnant (mean [SD], 13 [20]; P = 0.02; odds ratio, 1.05; 95% confidence interval, 1.00-1.09), were aware of their adolescent's rights to confidential contraception (62%; P = 0.006; odds ratio, 3.18; 95% confidence interval, 1.39-7.28), and had slightly older teens (16 vs 15.5 years, P = 0.01). More parents accepted OCPs over IUDs in the PED (53/58, 91% vs 26/57, 46%). CONCLUSIONS Although most parents were accepting of the PED provider offering confidential contraception to their adolescent, more parents preferred to be involved with decisions regarding contraception, in a collaborative approach. Further research is necessary to better elucidate parental/adolescent preferences.
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Affiliation(s)
| | | | | | - Andrea Pollack
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Julia Lieberman
- From the UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - Kristine Ruppert
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA
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Knowles K, Dowshen N, Lee S, Tanner A. Developing a Consensus for Adolescent and Young Adult mHealth HIV Prevention Interventions in the United States: A Delphi Method Study. JMIR Form Res 2022; 6:e25982. [PMID: 35819824 PMCID: PMC9328782 DOI: 10.2196/25982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 06/09/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Engaging adolescents and young adults (AYAs) who are at elevated risk for HIV acquisition or who are living with HIV in health care has posed a major challenge in HIV prevention and care efforts. Mobile health (mHealth) interventions are a popular and accessible strategy to support AYA engagement despite barriers to care present along the HIV care continuum. Even with progress in the field of mHealth research, expert recommendations for the process of designing, evaluating, and implementing HIV-related mHealth interventions are underdeveloped.
Objective
The aim of this study was to compile expert recommendations on the development, evaluation, and implementation of AYA-focused HIV prevention and care mHealth interventions.
Methods
Experts from adolescent mHealth HIV research networks and investigators of recently funded HIV mHealth projects and programs were identified and invited to complete a series of electronic surveys related to the design, implementation, and evaluation of HIV-related mHealth interventions. A modified Delphi method was used to ask experts to score 35 survey items on a 4-point Likert scale from not important to very important and encouraged experts to leave additional comments in textboxes. Responses were reviewed by the researchers, a team of 4 HIV mHealth intervention experts. The average importance ratings from survey responses were calculated and then categorized as retained (high importance), flagged (mid-level importance), or dropped (no/low importance). Additionally, thematic analysis of expert comments helped modify survey items for the next survey round. An evaluation of the level of agreement among experts on the most important items followed each round until consensus was reached.
Results
Of the 35 invited experts, 23 completed the first survey representing a variety of roles within a research team. Following two rounds of Delphi surveys, experts scored 24 of the 28 (86%) survey items included in round two as important to very important. The final consensus items included 24 recommendations related to the mHealth intervention design process (n=15), evaluation (n=2), and implementation (n=7). The 3 survey items with the highest average scores focused on the design process, specifically, (1) the creation of a diverse team including researchers, app software developers, and youth representation; (2) the importance of AYA-focused content; and (3) the value of an iterative process. Additionally, experts highlighted the importance of establishing the best ways to collect data and the types of data for collection during the evaluation process as well as constructing a plan for participant technology disruption when implementing an mHealth intervention.
Conclusions
The modified Delphi method was a useful tool to convene experts to determine recommendations for AYA-focused HIV prevention and care mHealth interventions. These recommendations can inform future mHealth interventions. To ensure the acceptability, feasibility, and efficacy of these AYA HIV prevention interventions, the focus must be on the specific needs of AYAs by including representation of AYAs in the process, including consistent and relevant content, ensuring appropriate data is collected, and considering technology and health accessibility barriers.
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Affiliation(s)
- Kayla Knowles
- PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, United States
| | - Nadia Dowshen
- PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, United States
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Susan Lee
- PolicyLab, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, PA, United States
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Amanda Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
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Chernick LS, Wallace BK, Potkin MT, Bell DL, Dayan PS. Adolescent Male Receptivity of and Preferences for Sexual Health Interventions in the Emergency Department. Pediatr Emerg Care 2022; 38:213-218. [PMID: 35482494 PMCID: PMC9051453 DOI: 10.1097/pec.0000000000002563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Male adolescents frequently present to the emergency department (ED) and many participate in behaviors increasing their risk of sexually transmitted infections and unintended pregnancies. Although the ED visit may represent an intervention opportunity, how best to design and deliver a sexual health intervention matching the preferences of adolescent male users is unclear. Our objective was to explore receptivity to and preferences for sexual health interventions among adolescent male ED patients. METHODS In this qualitative study, we asked sexually active male ED patients aged 14 to 21 years about their attitudes toward ED-based sexual health interventions and preferences for intervention modalities. Participants interacted with an early prototype of a digital intervention to gather specific feedback. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo. RESULTS Participants (n = 42) were predominantly 18 to 21 years (63%) and Hispanic (79%). Although most (71%) had sex in the prior 3 months, 45% did not use a condom at last intercourse and 17% had impregnated a partner. Participants viewed the ED visit as unused time without distracting influences, suitable for educational sexual health interventions. They considered ED-based digital interventions a reliable and confidential source of information. Engaging interventions allowed user control and provided novel and relatable content. CONCLUSIONS Adolescent male ED patients are receptive to ED-based digital sexual health interventions. These identified preferences should be considered when designing future user-informed sexual health interventions for the ED setting.
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Affiliation(s)
- Lauren S. Chernick
- Associate Professor of Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Irving Medical Center (CUIMC), 3959 Broadway, CHN1-116, New York, NY 10032, USA
| | - Brendan K. Wallace
- Medical Student, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168 St, New York, NY 10032 USA
| | - Maxmoore T. Potkin
- Medical Student, Columbia University Vagelos College of Physicians and Surgeons, 630 West 168 St, New York, NY 10032 USA
| | - David L. Bell
- Associate Professor of Pediatrics, Department of Pediatrics, CUIMC, and Population and Family Health, Mailman School of Public Health, CUIMC, 722 W 168 St New York, NY 10032 USA
| | - Peter S. Dayan
- Professor of Emergency Medicine, Division of Pediatric Emergency Medicine, Department of Emergency Medicine, CUIMC, 3959 Broadway, CHN1-116, New York, NY 10032 USA
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Chernick LS, Santelli J, Stockwell MS, Gonzalez A, Ehrhardt A, Thompson JL, Leu CS, Bakken S, Westhoff CL, Dayan PS. A multi-media digital intervention to improve the sexual and reproductive health of female adolescent emergency department patients. Acad Emerg Med 2022; 29:308-316. [PMID: 34738284 PMCID: PMC8960324 DOI: 10.1111/acem.14411] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Adolescent females presenting to emergency departments (EDs) inconsistently use contraceptives. We aimed to assess implementation outcomes and potential efficacy of a user-informed, theory-based digital health intervention developed to improve sexual and reproductive health for adolescent females in the ED. METHODS We conducted a pilot-randomized controlled trial of sexually active female ED patients age 14-19 years. Participants were randomized to the intervention Dr. Erica (Emergency Room Interventions to improve the Care of Adolescents) or usual care. Dr. Erica consists of an ED-based digital intervention along with 3 months of personalized and interactive multimedia messaging. We assessed the feasibility, adoption, and fidelity of Dr. Erica among adolescent female users. Initiation of highly effective contraception was the primary efficacy outcome. RESULTS We enrolled 146 patients; mean (±SD) age was 17.7 (±1.27) years and 87% were Hispanic. Dr. Erica demonstrated feasibility, with high rates of consent (84.4%) and follow-up (82.9%). Intervention participants found Dr. Erica acceptable, liking (98.0%, on Likert scale) and recommending (83.7%) the program. A total of 87.5% adopted the program, responding to at least one text; a total of 289 weblinks were clicked. Dr. Erica demonstrated fidelity; few participants opted out (6.9%) and failed to receive texts (1.4%). Contraception was initiated by 24.6% (14/57) in the intervention and 21.9% (14/64) in the control arms (absolute risk difference [ARD] = 2.7%, 95% confidence interval [CI] = -12.4% to 17.8%). Participants receiving Dr. Erica were more likely to choose a method to start in the future (65.9% [27/41]) than controls (30.0% [15/50]); ARD = 35.9%, 95% CI = 16.6% to 55.1%). CONCLUSIONS A personalized, interactive digital intervention was feasible to implement, acceptable to female ED patients and demonstrated high fidelity and adoption. This ED-based intervention shows potential to improve contraception decision making.
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Affiliation(s)
- Lauren S Chernick
- Department of Emergency Medicine, Columbia University Medical Center
| | - John Santelli
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Melissa S Stockwell
- Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center,Department of Pediatrics, Columbia University Medical Center
| | - Ariana Gonzalez
- Department of Emergency Medicine, Columbia University Medical Center
| | - Anke Ehrhardt
- Department of Psychology, Columbia University Medical Center
| | - John L.P. Thompson
- Department of Biostatistics, Columbia Mailman School of Public Health and Department of Neurology, Columbia University Medical Center
| | - Cheng-Shiun Leu
- Department of Biostatistics, Columbia Mailman School of Public Health
| | - Susanne Bakken
- Department of Nursing and Bioinformatics, Columbia University Medical Center
| | - Carolyn L. Westhoff
- Department of Obstetrics-Gynecology and Department of Population and Family Health, Columbia Mailman School of Public Health, Columbia University Medical Center
| | - Peter S Dayan
- Department of Emergency Medicine, Columbia University Medical Center
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10
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Miller MK, Catley D, Adams A, Staggs VS, Dowd MD, Stancil SL, Miller E, Satterwhite CL, Bauermeister J, Goggin K. Brief Motivational Intervention to Improve Adolescent Sexual Health Service Uptake: A Pilot Randomized Controlled Trial in the Emergency Department. J Pediatr 2021; 237:250-257.e2. [PMID: 34144031 DOI: 10.1016/j.jpeds.2021.06.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/01/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To test the hypothesis that our motivational sexual health intervention (SexHealth) would increase health service uptake when compared with control. STUDY DESIGN In a randomized controlled trial at a pediatric emergency department, sexually active adolescents received either the SexHealth intervention or printed materials (control). SexHealth, delivered by a health educator, was a tablet-based, interactive intervention that included motivational techniques to promote sexual health, condom skills training, and tailored service recommendations. We assessed feasibility (eg, intervention completion, recommendations discussed, intervention duration), acceptability (ie, proportion enrolled and rating intervention as satisfactory), and efficacy; secondary outcomes were sexual and care-seeking behaviors at 6 months. The efficacy outcome was completion of ≥1 service at the index visit (ie, counseling, condoms, emergency contraception for immediate or future use, pregnancy/sexually transmitted infection/HIV testing, sexually transmitted infection treatment, and clinic referral). RESULTS We enrolled 91 participants (intervention = 44; control = 47). The intervention demonstrated high feasibility: 98% completed the intervention; 98% of recommendations were discussed; duration was 24.6 minutes, and acceptability: 87% of eligible adolescents enrolled and 93% rated the intervention as fairly to very satisfactory. Compared with controls, intervention participants were more likely to complete ≥1 service (98% vs 70%, P < .001) including HIV testing (33% vs 6%, P = .02) and emergency contraception (80% vs 0%, P = .01). There were no meaningful differences between arms in behaviors at follow-up. CONCLUSIONS SexHealth was feasible to implement, acceptable to youth, and resulted in increased uptake of health services during the emergency department visit. Additional strategies may be needed to extend intervention effects over time. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov; NCT03341975.
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Affiliation(s)
- Melissa K Miller
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO.
| | - Delwyn Catley
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Amber Adams
- Children's Mercy Kansas City, Kansas City, MO
| | - Vincent S Staggs
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - M Denise Dowd
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Stephani L Stancil
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Elizabeth Miller
- University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | | | | | - Kathy Goggin
- Children's Mercy Kansas City, Kansas City, MO; University of Missouri-Kansas City School of Medicine, Kansas City, MO; University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA; University of Missouri-Kansas City School of Pharmacy, Kansas City, MO
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11
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Rosentel K, VandeVusse A, Schuh T. The Sexual and Reproductive Health Burden Index: Development, Validity, and Community-Level Analyses of a Composite Spatial Measure. J Urban Health 2021; 98:481-495. [PMID: 32748283 PMCID: PMC8382809 DOI: 10.1007/s11524-020-00457-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Sexual and Reproductive Health Burden Index (SRHBI) was developed to provide a composite spatial measure of sexual and reproductive health (SRH) indicators that can be widely adopted by urban public health departments for the planning of SRH services. The index was constructed using eight indicators: teen births, low birthweight, infant mortality, new HIV diagnoses, people living with HIV, and incidences of gonorrhea, chlamydia, and syphilis. Chicago Department of Public Health data (2014-2017) were used to calculate index scores for Chicago community areas; scores were mapped to provide geovisualization and global Moran's I was calculated to assess spatial autocorrelation. Cronbach's alpha was calculated to assess internal reliability of the SRHBI. Pearson correlations were conducted to assess concurrent validity and correlation with community-level factors. Linear regression was conducted to assess community-level predictors of the SRHBI. Application of the SRHBI in Chicago demonstrates substantial variation in SRH burden across Chicago's urban landscape with significant spatial autocorrelation of scores (I = .580, p = .001). Internal reliability of the measure was excellent with α = .937. The SRHBI was significantly correlated with other indicators of SRH including rate of prenatal care initiation in the first trimester, rate of preterm births, reported sexual assault incidence, cervical cancer incidence, prostate cancer incidence, and rate of smoking during pregnancy. This suggests good concurrent validity of the measure. Linear regression revealed that the percent of Black residents, percent of household couples that are same-sex, community violence, economic hardship, and population density were significant predictors of the SRHBI. The SRHBI provides a valid, useful, and replicable measure to assess and communicate community-level SRH burden in urban environments. The SRHBI may be scaled through a multi-city public data dashboard and utilized by urban public health departments to optimally target and tailor SRH interventions to communities.
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Affiliation(s)
- Kris Rosentel
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | - Tina Schuh
- Erie Family Health Center, Chicago, IL, USA
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12
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Alexander AB, Chernoby K, VanderVinne N, Doos Y, Kaur N, Bernard C, Kline JA. Acceptability of Contraceptive Services in the Emergency Department: A Cross-sectional Survey. West J Emerg Med 2021; 22:769-774. [PMID: 34125059 PMCID: PMC8203030 DOI: 10.5811/westjem.2021.2.49675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Unintended pregnancy disproportionately affects marginalized populations and has significant negative health and financial impacts on women, their families, and society. The emergency department (ED) is a promising alternative setting to increase access to sexual and reproductive health (SRH) services including contraception, especially among marginalized populations. The primary objective of this study was to determine the extent to which adult women of childbearing age who present to the ED would be receptive to receiving contraception and/or information about contraception in the ED. As a secondary objective, we sought to identify the barriers faced in attempting to obtain SRH care in the past. Methods We conducted a quantitative, cross-sectional, assisted, in-person survey of women aged 18–50 in the ED setting at two large, urban, academic EDs between June 2018–September 2019. The survey was approved by the institutional review board. Survey items included demographics, interest in contraception initiation and/or receiving information about contraception in the ED, desire to conceive, prior SRH care utilization, and barriers to SRH. Results A total of 505 patients participated in the survey. Participants were predominantly single and Black, with a mean age of 31 years, and reporting not wanting to become pregnant in the next year. Of those participants, 55.2% (n = 279) stated they would be interested in receiving information about birth control AND receiving birth control in the ED if it were available. Of those who reported the ability to get pregnant, and not desiring pregnancy in the next year (n = 279, 55.2%), 32.6% were not currently using anything to prevent pregnancy (n = 91). Only 10.5% of participants stated they had experienced barriers to SRH care in the past (n = 53). Participants who experienced barriers to SRH reported higher interest in receiving information and birth control in the ED (74%, n = 39) compared to those who had not experienced barriers (53%, n = 240); (P = 0.004, 95% confidence interval, 1.30–4.66). Conclusion The majority of women of childbearing age indicated the desire to access contraception services in the ED setting. This finding suggests favorable patient acceptability for an implementation study of contraception services in emergency care.
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Affiliation(s)
- Andreia B Alexander
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Kimberly Chernoby
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Nathan VanderVinne
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
| | - Yancy Doos
- Indiana University-Purdue University, School of Science, Indianapolis, Indiana
| | - Navneet Kaur
- Indiana University-Purdue University, School of Science, Indianapolis, Indiana
| | - Caitlin Bernard
- Indiana University School of Medicine, Department of Obstetrics and Gynecology, Indianapolis, Indiana
| | - Jeffrey A Kline
- Indiana University School of Medicine, Department of Emergency Medicine, Indianapolis, Indiana
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13
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Pickett ML, Hoehn EF, Visotcky AM, Norman B, Drendel AL. Adolescents' Awareness of and Attitudes Toward Expedited Partner Therapy Provided in the Emergency Department. Sex Transm Dis 2021; 47:754-759. [PMID: 33045164 DOI: 10.1097/olq.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adolescents and young adults account for half of the 20 million new cases of sexually transmitted infections each year. Expedited partner therapy (EPT) has been shown to decrease reinfection rates and is recommended by the Centers for Disease Control and Prevention. We aimed to (1) assess adolescents' awareness of EPT, (2) assess their likelihood of giving EPT received in the pediatric emergency department (PED) to their partner(s), and (3) identify factors associated with increased likelihood of giving EPT to their partner(s). METHODS Adolescents and young adults aged 14 to 22 years seeking care in 2 PEDs participated in a survey. Main outcomes were EPT awareness and likelihood of giving EPT to his/her partner(s). Patients were dichotomized into likely and not likely to provide partner(s) with EPT based on answers to a 5-point Likert scale question. χ and t tests were used to analyze the data. RESULTS Three hundred ninety-three participants were included. Only 11% (n = 42) were aware of EPT; however, 80% (n = 316) reported to be likely to give EPT received in the PED to his/her partner(s). Study site, being sexually active, and engaging in high-risk sexual behaviors were associated with an increased likelihood of giving EPT to their partner(s) (P < 0.05). CONCLUSIONS Many adolescents are not aware of EPT; however, most were theoretically likely to give EPT received in the PED to his/her partner(s). With increasing rates of sexually transmitted infections and high utilization of the PED for adolescent reproductive health services, efforts to incorporate the use of EPT in PED workflows would be beneficial.
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Affiliation(s)
- Michelle L Pickett
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | | | - Alexis M Visotcky
- Institute for Health and Equity, Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI
| | - Brandy Norman
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
| | - Amy L Drendel
- From the Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI
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14
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Reed JL, Alessandrini EA, Dexheimer J, Kachelmeyer A, Macaluso M, Zhang N, Kahn JA. Effectiveness of a Universally Offered Chlamydia and Gonorrhea Screening Intervention in the Pediatric Emergency Department. J Adolesc Health 2021; 68:57-64. [PMID: 33143985 PMCID: PMC7755827 DOI: 10.1016/j.jadohealth.2020.09.040] [Citation(s) in RCA: 4] [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: 06/10/2020] [Revised: 08/08/2020] [Accepted: 09/27/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Adolescents represent more than half of the newly diagnosed sexually transmitted infections in the U.S. annually. Emergency departments (EDs) may serve as an effective, nontraditional setting to screen for chlamydia/gonorrhea (CT/GC). The objective was to evaluate the effectiveness of a universally offered CT/GC screening program in two pediatric ED settings. METHODS This was a prospective, delayed start pragmatic study conducted over 18 months in two EDs within the same academic institution among ED adolescents aged 14-21 years with any chief complaint. Using a tablet device, adolescents were confidentially informed of CT/GC screening recommendations and were offered screening. If patients agreed to CT/GC testing, a clinical decision support tool was triggered to inform the provider and order testing. The main and key secondary outcomes were the proportion of CT/GC testing and positive CT/GC test results in each respective ED. RESULTS Both EDs experienced modest but statistically significant increases in CT/GC testing post- versus pre-intervention (main: 11.5% vs. 7.9%; confidence interval [CI]: 2.9-4.2; p < .0001 and satellite: 3.8% vs. 2.6%; 95% CI: .7-1.7; p < .0001). Among those tested, the positivity rate at the main ED did not significantly change post- versus pre-intervention (24.1% vs. 23.2%; 95% CI: -1.9 to 3.8; p = .71) but significantly decreased at the satellite ED (7.6% vs. 14.8%; 95% CI: -12.2 to -2.2; p = .01). CONCLUSIONS A universally offered screening intervention increased the proportion of adolescents who were tested at both EDs and the detection rates for CT/GC at the main ED, but patient acceptance of screening was low.
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Affiliation(s)
- Jennifer L Reed
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
| | - Evaline A Alessandrini
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; University of Cincinnati Health System, Cincinnati, Ohio
| | - Judith Dexheimer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Department of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrea Kachelmeyer
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Maurizio Macaluso
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nanhua Zhang
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jessica A Kahn
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio; Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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15
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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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16
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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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