Did the 2011 AAP recommendations on youth HIV testing change practice? Trends from a large urban adolescent program

Abstract

Purpose: The purpose of this study was to determine whether there is adherence to the October 2011 American Academy of Pediatrics (AAP) recommendations for HIV screening in a large urban adolescent program with availability of a publicly funded program providing free, confidential, sexually transmitted infection (STI) and HIV counseling and testing (then rapid or third generation HIV testing), nested in the same adolescent clinic. Methods: We conducted a retrospective chart review of HIV screening trends among 13-to 24-year-old patients tested for HIV during periods of January 2010 to June 2011 (18 months pre-AAP recommendations period) and July 2011 to December 2012 (18-month period, which included 15 months after the AAP recommendations). Results: During the period of January 2010 to June 2011, there were 22 tests/1,000 medical visits (N = 824 of 37,520 medical visits), and during the period of July 2011 to December 2012, there were 27 tests/1,000 medical visits (N = 1,068 of 38,763 medical visits) (p < 0.0001, odds ratio [OR] 1.26). The number of 13-to 18-year-old patients screened in the pre-AAP period was 150, compared to 297 in the second 18-month period (X2 = 43.3, df = 1, p < 0.0001). A summative risk profile score of 0-9 was created in the form of a continuous variable, with a risk score of 0 for those with no risk factor identified and 1 point for each risk behavior identified. The proportion of HIV test clients with zero-specified risk (a risk score of “0”) increased from 2010 to 2012. Conclusion: Release of the 2011 AAP HIV testing guidelines was associated with a modest increase in HIV screening and a shift toward testing younger people and away from risk-based screening.