HIV Testing Among Adolescents With Acute Sexually Transmitted Infections

Abstract

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.

Rates of Appropriate Treatment and Follow-Up Testing After a Gonorrhea and/or Chlamydia Infection in an Urban Network of Federally Qualified Health Center Systems

“…13 Factors associated with not receiving treatment and/or postinfection laboratory testing include female sex, Hispanic ethnicity, STI history, and lack of insurance. 13,14 Because most prior studies looking at the treatment of GC and CT were performed in emergency departments, little is known about the rates of treatment and follow-up laboratory From the…”

A retrospective study of HIV pre‐exposure prophylaxis counselling among non‐Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019

“…We conducted a retrospective cohort study of a convenience sample of youth aged 13–24 years who sought STI testing and treatment between June 2014 and June 2019 at two academically affiliated clinics that both provided collocated paediatric/adolescent primary care services and confidential sexual/reproductive health services in Philadelphia, Pennsylvania [ 36 , 50 ]. Youth without insurance were not able to access primary care services at the sites.…”

“…An institution‐wide EHR was implemented prior to January 2014. STI and HIV testing data from the two clinics were captured in near‐real time from the medical system's STI database using a commercial business intelligence application (Qlik, Radnor, PA) [ 36 , 50 ]. We performed EHR data abstraction using a standardized electronic data abstraction instrument to obtain information associated with each STI encounter collected as part of routine patient care measures.…”

“…Prior studies have found that when young people have established relationships with a trusted healthcare provider and confidentiality concerns are addressed, they are more likely to access healthcare, communicate about sexual and mental health, and return for care [ 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. Conversely, studies have demonstrated suboptimal rates of HIV/STI screening and sexual health‐related discussions between youth and healthcare providers [ 30 , 31 , 32 , 33 , 34 , 35 , 36 ], which may adversely affect the provider's ability to assess the patient's sexual health goals, HIV risk and prevention behaviours, and HIV prevention needs—including provider‐initiated PrEP counselling with PrEP‐eligible youth.…”

Technology-Based Interventions to Increase Point-of-Care HIV Testing and Linkage to Care Among Youth in the US: A Systematic Review

“…Yet, despite recommendations for routine HIV testing for adolescents and young adults in all clinical settings [27,28], research indicates that youth are often not tested for HIV [10,29,30]. For example, in a study of youth receiving care for acute sexually transmitted infections (STIs) in large urban primary care clinics only 55% of patients received an HIV test [31]. This is despite recommendations that all patients being tested and treated for STIs also be tested for HIV [32].…”