HIV Testing Among Adolescents With Acute Sexually Transmitted Infections

In this study, we demonstrate that only 55% of adolescent STI episodes are tested for HIV and identify significant patient and health care factors associated with HIV testing. BACKGROUND AND OBJECTIVES: Rates of sexually transmitted infections (STIs) have increased over the decade. Guidelines recommend HIV testing with incident STIs. Prevalence and factors associated with HIV testing in acute STIs are unknown in adolescents. Our objective was to determine the prevalence of completed HIV testing among adolescents with incident STIs and identify patient and health care factors associated with HIV testing. METHODS: Retrospective study of STI episodes (gonorrhea, Chlamydia, trichomoniasis, or syphilis) of adolescents between 13 and 24 years old from July 2014 to December 2017 in 2 urban primary care clinics. We performed mixed effects logistic regression modeling to identify patient and health care factors associated with HIV testing within 90 days of STI diagnosis. RESULTS: The 1313 participants contributed 1816 acute STI episodes. Mean age at STI diagnosis was 17.2 years (SD = 1.7), 75% of episodes occurred in females, and 97% occurred in African Americans. Only half (55%) of acute STI episodes had a completed HIV test. In the adjusted model, female sex, previous STIs, uninsured status, and confidential sexual health encounters were associated with decreased odds of HIV testing. Patients enrolled in primary care at the clinics, compared with those receiving sexual health care alone, and those with multipathogen STI diagnoses were more likely to have HIV testing. CONCLUSIONS: HIV testing rates among adolescents with acute STIs are suboptimal. Patient and health care factors were found to be associated with receipt of testing and should be considered in clinical practice.

[1]  Carole Treston.  Ending the HIV Epidemic: A Plan for America-Nurses Needed. , 2019, The Journal of the Association of Nurses in AIDS Care : JANAC.

[2]  S. Sansom,et al.  Vital Signs: HIV Transmission Along the Continuum of Care — United States, 2016 , 2019, MMWR. Morbidity and mortality weekly report.

[3]  Sarah M. Wood,et al.  Effectiveness of a Quality Improvement Intervention to Improve Rates of Routine Chlamydia Trachomatis Screening in Female Adolescents Seeking Primary Preventive Care. , 2019, Journal of pediatric and adolescent gynecology.

[4]  J. Jennings,et al.  Human Immunodeficiency Virus Diagnosis After a Syphilis, Gonorrhea, or Repeat Diagnosis Among Males Including non–Men Who Have Sex With Men: What Is the Incidence? , 2018, Sexually transmitted diseases.

[5]  Sarah M. Wood,et al.  Missed Opportunities for HIV Screening Among a Cohort of Adolescents With Recently Diagnosed HIV Infection in a Large Pediatric Hospital Care Network. , 2018, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[6]  Elizabeth A Torrone,et al.  Sexually transmitted disease surveillance 2017 , 2018 .

[7]  Christopher P. Salas-Wright,et al.  Adolescent Experiences of Clinician–Patient HIV/STI Communication in Primary Care , 2018, Health communication.

[8]  K. Ethier,et al.  Youth Risk Behavior Surveillance — United States, 2017 , 2018, Morbidity and mortality weekly report. Surveillance summaries.

[9]  P. Arguin,et al.  Malaria Surveillance — United States, 2015 , 2018, Morbidity and mortality weekly report. Surveillance summaries.

[10]  H. Friedman,et al.  Knowledge of HIV Testing Guidelines Among US Internal Medicine Residents: A Decade After the Centers for Disease Control and Prevention's Routine HIV Testing Recommendations , 2018, AIDS patient care and STDs.

[11]  L. Meredith,et al.  Influence of mental health and alcohol or other drug use risk on adolescent reported care received in primary care settings , 2018, BMC Family Practice.

[12]  Christopher P. Salas-Wright,et al.  The Usability and Acceptability of an Adolescent mHealth HIV/STI and Drug Abuse Preventive Intervention in Primary Care , 2018, Behavioral medicine.

[13]  L. Tabb,et al.  The Effect of PrEP on HIV Incidence Among Men Who Have Sex With Men in the Context of Condom Use, Treatment as Prevention, and Seroadaptive Practices , 2017, Journal of acquired immune deficiency syndromes.

[14]  L. Wang,et al.  Human Immunodeficiency Virus, Chlamydia, and Gonorrhea Testing in New York Medicaid–Enrolled Adolescents , 2017, Sexually transmitted diseases.

[15]  Catherine A. Sugar,et al.  Integrated Primary Medical-Behavioral Health Care for Adolescent and Young Adult Depression: Predictors of Service Use in the Youth Partners in Care Trial , 2017, Journal of pediatric psychology.

[16]  S. Swaminathan,et al.  Missed Testing Opportunities for HIV Screening and Early Diagnosis in an Urban Tertiary Care Center , 2017, AIDS research and treatment.

[17]  J. Raifman,et al.  Insurance Coverage and Utilization at a Sexually Transmitted Disease Clinic in a Medicaid Expansion State , 2017, Sexually transmitted diseases.

[18]  Connie Lim,et al.  Youth Risk Behavior Surveillance - United States, 2015. , 2016, Morbidity and mortality weekly report. Surveillance summaries.

[19]  L. Zeltzer,et al.  Integrated Medical-Behavioral Care Compared With Usual Primary Care for Child and Adolescent Behavioral Health: A Meta-analysis. , 2015, JAMA pediatrics.

[20]  J. Skarbinski,et al.  Human immunodeficiency virus transmission at each step of the care continuum in the United States. , 2015, JAMA internal medicine.

[21]  J. Gerber,et al.  Clinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus. , 2014, The Journal of pediatrics.

[22]  Nadia L. Dowshen,et al.  Pediatric primary care provider practices, knowledge, and attitudes of human immunodeficiency virus screening among adolescents. , 2013, The Journal of pediatrics.

[23]  F. Leung,et al.  Understanding the demographic characteristics and health of medically uninsured patients. , 2013, Canadian family physician Medecin de famille canadien.

[24]  K. Underhill.  Paying for Prevention: Challenges to Health Insurance Coverage for Biomedical HIV Prevention in the United States , 2012, American Journal of Law & Medicine.

[25]  Jeannine S. Schiller,et al.  Summary health statistics for u.s. Adults: national health interview survey, 2011. , 2012, Vital and health statistics. Series 10, Data from the National Health Survey.

[26]  Patrick A Ryscavage,et al.  Clinical Outcomes of Adolescents and Young Adults in Adult HIV Care , 2011, Journal of acquired immune deficiency syndromes.

[27]  I. Yermilov,et al.  HIV Screening in Commercially Insured Patients Screened or Diagnosed With Sexually Transmitted Diseases or Blood-Borne Pathogens , 2011, Sexually transmitted diseases.

[28]  J. Klausner,et al.  Rectal Gonorrhea and Chlamydia Reinfection Is Associated With Increased Risk of HIV Seroconversion , 2010, Journal of acquired immune deficiency syndromes.

[29]  J. Klein,et al.  Current Pediatrician Practices in Identifying High-risk Behaviors of Adolescents , 2010, Pediatrics.

[30]  J. Levi,et al.  Insurance coverage and access to HIV testing and treatment: considerations for individuals at risk for infection and for those with undiagnosed infection. , 2007, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[31]  Myron S. Cohen,et al.  The role of sexually transmitted diseases in HIV transmission , 2004, Nature Reviews Microbiology.