Characteristics of youth agreeing to electronic sexually transmitted infection risk assessment in the emergency department

Abstract

Objectives Adolescents and young adults are at high risk for sexually transmitted infections (STIs). We previously reported an increase in STI testing of adolescents in our ED by obtaining a sexual history using an Audio-enhanced Computer-Assisted Self-Interview (ACASI). We now examine associations among demographics, sexual behaviour, chief complaint and willingness to be tested. Methods This was a prospective study conducted in a paediatric ED between April and December 2011. After triage, eligible patients between 15 and 21 years presenting with non-life-threatening conditions were asked to participate in the study. Consenting participants used an ACASI to provide their demographic data and answer questions about their sexual history and willingness to be tested. Our primary outcome was the association of demographics, chief complaint and ACASI recommendation with the participant’s willingness to be tested. Results We approached 1337 patients, of whom 800 (59%) enrolled and completed the ACASI. Eleven who did not answer questions related to their sexual history were excluded from analysis. Of 789 participants, 461 (58.4%) were female and median age was 16.9 years (IQR 16.0–17.8); 509 (64.5%) endorsed a history of anal, oral and/or vaginal intercourse. Disclosing a sexual history and willingness to be tested did not differ significantly by gender. 131 (16.6%) had a chief complaint potentially referable to an STI; among the 658 participants with non-STI-related complaints, 412 (62.6%) were sexually active, many of whom disclosed risky behaviours, including multiple partners (46.4%) and inconsistent condom use (43.7%). The ACASI identified 419 patients as needing immediate STI testing; the majority (81%) did not have a chief complaint potentially related to STIs. 697 (88.3%) participants were willing to receive STI testing. Most (94.6%) of the patients with STI-related complaints were willing to be tested, and 92.1% of patients with a recommendation for immediate testing by the ACASI indicated a willingness to be tested. Conclusions Adolescents were willing to disclose sexual activity via electronic questionnaires and were willing to receive STI testing, even when their chief complaint was not STI related. The ACASI facilitated identification of adolescent ED patients needing STI testing regardless of chief complaint.

Electronic Screening for Adolescent Risk Behaviors in the Emergency Department: A Randomized Controlled Trial

“…However, the literature supports that adolescents are open to risk-behavior screening in the ED regardless of their chief complaint. Studies have found acceptability for both specific risk behaviors such as substance abuse; 15 pregnancy prevention; 33 sexually transmitted infection risk; [34][35][36] depression; 37 suicidality; 38 and for comprehensive screening across a battery of five risk behaviors (substance use, violence, depression, human trafficking, and access to firearms). 39 Risk behavior screening in the ED is an important tool for adolescent health as it can reach a population that does not frequently access preventive healthcare.…”

Emergency Department Directors Are Willing to Expand Reproductive Health Services for Adolescents

“…This is a relevant issue, as adolescents and adults in both the pediatric ED and other settings have indicated they prefer answering questions regarding their sexual history via electronic questionnaire, and in some instances, they provide more comprehensive and accurate information using electronic questionnaires. 13,[30][31][32][33][34][35][36][37] Thus, the preference expressed by most ED directors we surveyed to gather this kind of sensitive information during faceto-face interviews seems questionable. Based on these findings, ED physicians likely will need to adjust both their individual practice and ED workflows to accommodate expanded reproductive healthcare interventions in the pediatric ED.…”

Acceptability and uptake of HIV self‐testing in emergency care settings: A systematic review and meta‐analysis

“…This could include the use of varying approaches to screening and HIVST delivery either through digital interfaces as has been used in other sexually transmitted infection research, 55 or via more traditional patient-provider interactions. As well, the consideration of how ED-based HIVST programs best incorporate into the HIVspecific, and broader public health agendas from clinical applications and cost valuation perspectives in a given setting are key, as has been highlight by prior emergency care consensus recommendations.…”