798 - Missed Opportunities in Pediatric Emergency Departments to Identify Adolescents Living with HIV in Metro Atlanta

Publication Number: 798.5803

Mark Griffiths, Emory University School of Medicine, Atlanta, GA, United States; Sandy Francois, Emory University School of Medicine, Atlanta, GA, United States; Melissa Cameron, Emory University Department of Pediatric Emergency Medicine, Atlanta, GA, United States; Jordan Bryant, Emory University School of Medicine, Atlanta, GA, United States; Bridget Wynn, Emory University, Atlanta, GA, United States; Sara P. Brown, Children's Healthcare of Atlanta, Atlanta, GA, United States; Sarah Thompson, Children's Healthcare of Atlanta, Atlanta, GA, United States; Rebekah Carter, Children's Healthcare of Atlanta, ATlanta, GA, United States; Kelly DeNaples, Children's Healthcare of Atlanta, Atlanta, GA, United States; Swaminathan Kandaswamy, Emory University School of Medicine, Atlanta, GA, United States; Evan W. Orenstein, Emory University School of Medicine, Atlanta, GA, United States; Andres Camacho-Gonzalez, Emory University School of Medicine, Atlanta, GA, United States; Lauren Middlebrooks, Emory University School of Medicine, Atlanta, GA, United States; Claudia R.. Morris, Emory University School of Medicine, Atlanta, GA, United States

Background: Parts of metro Atlanta have HIV positive rates at 8-times the national average. The Centers for Disease Control and Prevention (CDC) recommends HIV screening for patients ≥13 years. Adolescents are the least likely group to know their HIV status, have the lowest rate of linkage-to-care and viral suppression. In July 2023, Children’s Healthcare of Atlanta (Children’s) implemented opt-out HIV testing in its emergency departments (ED) for patients ≥13 years undergoing venipuncture for any chief complaint at all their 3 sites as a first step toward universal opt-out testing. In its first year, 9 adolescents living with HIV (ALHIV) were identified with 0.2% positivity rate.

Objective: The objective is to review characteristics of these ALHIV and identify if there were opportunities for prevention or interventions prior to their positive results.

Design/Methods: Children’s electronic medical record EPIC and its population discovery tool was used to evaluate the 9 ALHIV. A missed opportunity was described as any ED or urgent care visit in the past 24 months without HIV screening prior to each positive test result. Findings were cross-referenced to determine prior ED visits, prior testing, previous sexually transmitted infections, and any other comorbidity. The data was compared using descriptive statistical methods.

Results: All 9 ALHIV were evaluated, 2(22%) girls and 7(78%) boys. The mean age (± standard deviation) was 15.7±1.9. In our ALHIV, 56% were coinfected with other sexually transmitted infections (STIs): 80% chlamydia, 40% herpes simplex virus, 40% syphilis, 40% trichomonas and 20% gonorrhea. Geographically 89% of positives results were from metro Atlanta with the rest being from a rural county. In the past 24 months, 67% visited an ED (n=6) and 11% visited an urgent care (n=1). The most frequent chief complaint in 7 patients (78%) was a sore throat and other with flu-like symptom suggestive of a characteristic sign of early HIV infection. None received an HIV test, which identified 7 of our ALHIV (78%) as potential missed opportunities.

Conclusion(s): These missed opportunities for potential early identification highlight the low HIV testing rates in adolescents despite CDC recommendations and support universal testing. Our implementation of opt-out HIV testing has raised our testing rates, and we anticipate a decrease in missed opportunities going forward. Future efforts include staff education, improving pediatric sexual health screening, expansion to outpatient clinics and wards, and targeting patients with STIs for comprehensive STI preventive resources to address this public health crisis.