Soyemi Kenneth, Muisyo Teddy, KariKari Yaa, Lee Kun-Uk David, Nguyen Peter, Simpson Karen E, Regis Kevin, Reid Lisa Henry
Department of Pediatrics, Cook County Health and Hospitals System, John H Stroger Jr Hospital, Chicago, IL, USA,
Department of Emergency Medicine, Cook County Health and Hospitals System, John H Stroger Jr Hospital, Chicago, IL, USA,
HIV AIDS (Auckl). 2018 Oct 8;10:177-180. doi: 10.2147/HIV.S172474. eCollection 2018.
HIV testing in the Pediatric Emergency Department (PED) is a novel concept as adolescents, and young adults, use the PED as point of care or first point of contact with the health care system. Our objective was to study the HIV nontesting data and factors that influenced testing decision among patients receiving care in our PED. We designed a survey that inquired about testing acceptance, reasons for rejection, satisfaction with testing conditions, and understanding of the consequence of HIV test results. We approached 500 patients across all shifts in the PED; for analysis, categorical variables were created using demographic data (race, age, ethnicity, marital status, level of education). Forward conditional binary logistic regression was used to explore the effect of various independent predictors on HIV testing rejection with the strength of association measured with adjusted odds ratio (OR), and their 95% CIs. We conducted model fitting by plotting residuals, Hosmer and Lemeshow test statistic, and area under the curve completed using predicted probabilities. We used SPSS Version 25, Microsoft Excel 2016 for data preparation and analysis. Of the 500 patients approached, 423 (84.6%) completed the survey, median (interquartile) age of survey participants was 19 (17-20) years, 158 (37.4%) rejected HIV testing, 284 (67.1%) were older than 18 years of age, 200 (47.3%) were males, 154 (36.4%) were white, and 127 (30%) were of Hispanic origin. The most common reason for rejecting HIV was low risk perception declared by 79 (50%) respondents. In multivariate analysis, age <18 years (OR, 3.5; 95% CI, 2.3-5.5, <0.00) and being Hispanic (OR, 2.5; 95% CI, 1.6-3.8, <0.00) were significant predictors for respondent nontesting. Hosmer and Lemeshow test was not significant, =0.42, and area under the curve was 0.67 (95% CI, 0.61-0.76). Respondents, <18 years were more likely to reject HIV testing because of low perception of risk. Program addressing risk perception which emphasizes safe health practices should be developed to reduce HIV transmission.
在儿科急诊科（PED）进行HIV检测是一个新概念，因为青少年和年轻人将儿科急诊科作为医疗护理点或与医疗系统的首个接触点。我们的目标是研究在我们儿科急诊科接受治疗的患者中未进行HIV检测的数据以及影响检测决策的因素。我们设计了一项调查，询问检测接受情况、拒绝检测的原因、对检测条件的满意度以及对HIV检测结果后果的理解。我们在儿科急诊科的所有班次中接触了500名患者；为了进行分析，使用人口统计学数据（种族、年龄、族裔、婚姻状况、教育程度）创建分类变量。采用向前条件二元逻辑回归来探讨各种独立预测因素对HIV检测拒绝的影响，关联强度用调整后的比值比（OR）及其95%置信区间（CI）来衡量。我们通过绘制残差、Hosmer和Lemeshow检验统计量以及使用预测概率完成的曲线下面积来进行模型拟合。我们使用SPSS 25版、Microsoft Excel 2016进行数据准备和分析。在接触的500名患者中，423名（84.6%）完成了调查，调查参与者的年龄中位数（四分位间距）为19（17 - 20）岁，158名（37.4%）拒绝进行HIV检测，284名（67.1%）年龄超过18岁，200名（47.3%）为男性，154名（36.4%）为白人，127名（30%）为西班牙裔。拒绝HIV检测最常见的原因是79名（50%）受访者表示风险感知较低。在多变量分析中，年龄<18岁（OR，3.5；95% CI，2.3 - 5.5，<0.00）和为西班牙裔（OR，2.5；95% CI，1.6 - 3.8，<0.00）是受访者未进行检测的显著预测因素。Hosmer和Lemeshow检验不显著，P = 0.42，曲线下面积为0.67（95% CI，0.61 - 0.76）。年龄<18岁的受访者由于风险感知较低更有可能拒绝HIV检测。应制定强调安全健康做法的风险感知应对方案，以减少HIV传播。
