HIV Testing Underused for Adolescents With Acute STIs

By Will Boggs MD

March 18, 2020

NEW YORK (Reuters Health) - Adolescents with acute sexually transmitted infections (STIs) commonly do not undergo guideline-recommended HIV testing, according to a new study.

"In order to increase HIV testing rates in adolescents, I believe that we need to be helping pediatricians understand the importance of HIV testing and prevention," Danielle T. Petsis of Children's Hospital of Philadelphia told Reuters Health by email. "We also must make it easier for providers to notice when an adolescent is in need of an HIV test."

Adolescents and young adults (those 15 to 24 years old) represent only a quarter of sexually active individuals but account for half of incident STIs. The U.S. Centers for Disease Control and Prevention and the U.S. Preventive Services Task Force recommend risk-based HIV testing for individuals who test positive for an STI, but screening rates are low, and an estimated 44% of individuals 13 to 24 years old living with HIV remain undiagnosed.

To examine rates of HIV testing after an incident STI, Petsis and colleagues used data from two urban pediatric/adolescent primary-care clinics with high rates of incident STIs.

Among the 1,816 positive STI tests, only 55.1% had HIV testing completed within 90 days of STI diagnosis, and this resulted in one confirmed positive HIV result, the team reports in Pediatrics.

About three-quarters of the episodes in which HIV testing did not happen concurrently with STI testing had a follow-up visit, but the majority of these visits did not include HIV testing either.

In 26.9% of STI episodes in which HIV testing was not completed, the patient did not complete the HIV test ordered by the provider.

Factors associated with increased odds of completed HIV testing included enrollment in primary care and having a multipathogen infection at STI diagnosis.

On the other hand, having a history of previous STIs, being female, lacking insurance and having the incident STI diagnosed at a family-planning visit were associated with decreased odds of HIV testing.

"I hope that physicians are empowered to make a change in the midst of this HIV epidemic in our country that is affecting adolescents at high rates," Petsis said. "Creating lasting relationships with patients and connecting walk-ins with primary care allows providers more points of contact with patients. As STI rates continue to grow, especially in adolescents, providers should see every STI testing and treatment encounter as an opportunity for HIV testing."

"Comprehensive HIV testing and prevention for adolescents should be viewed differently than (for) adults," she said. "Primary care may be the best or only opportunity to connect with adolescents, especially those under the age of 18. While many pediatricians may not be used to having difficult sexual-health conversations with adolescents, it is important that providers have the time, capability, and education to recognize HIV risk among their patients."

SOURCE: Pediatrics, online March 16, 2020.