Morehouse School of Medicine.
From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.
Pediatr Emerg Care. 2022 Oct 1;38(10):e1613-e1619. doi: 10.1097/PEC.0000000000002772. Epub 2022 Jun 8.
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.
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.
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.
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.
本研究的目的是（1）比较儿科急诊部（PED）的目标性和常规 HIV 筛查，（2）比较医务人员记录的 HIV 风险评估与青少年在 PED 就诊期间对 HIV 风险评估的认知。
本前瞻性研究与 PED 常规 HIV 筛查试点同时进行。PED 医务人员可根据常规护理对青少年进行 HIV 检测（目标性检测）；如果未进行检测，则对其进行常规筛查试点。一部分青少年完成了一份关于 HIV 风险的问卷。采用 χ 2 分析比较了接受目标性检测和常规筛查的青少年。对接受 HIV 检测的患者询问是否进行了 HIV 风险评估；采用 κ 分析比较医务人员记录中的评估情况。
在 4 个月期间，有 107 名青少年接受了目标性检测，344 名青少年接受了常规筛查。一名 14 岁的患者通过常规筛查检测出阳性；该名青少年在 60 天内有 2 次未接受 PED 目标性检测的就诊。与常规筛查相比，接受目标性检测的青少年更可能为女性（82%比 57%，P < 0.001）、16 岁或以上（71%比 44%，P < 0.001），或有泌尿生殖/妇科问题（48%比 6%，P < 0.001）。目标性检测漏诊了有 HIV 风险因素的青少年，但他们接受了常规筛查。有医务人员记录的 HIV 风险评估的青少年更可能接受目标性检测。医务人员记录和青少年对 HIV 风险评估的认知之间存在中度一致性（κ = 0.61）。
PED 中 HIV 风险评估和检测存在差距，这可能会错失诊断青少年 HIV 的机会。常规 HIV 筛查可弥补这些差距，并扩大 PED 中青少年的 HIV 检测范围。
