Opportunities for earlier HIV diagnosis in a pediatric ED

Abstract

Objectives Emergency department HIV screening is recommended, but challenging to implement and of uncertain effectiveness in pediatric EDs (PEDs). We sought to determine whether there were opportunities for earlier HIV diagnosis in the PED for a cohort of young adults diagnosed with HIV. Methods This retrospective cohort study reviewed PED records of a group of young adults receiving HIV care in an urban hospital setting. PED visits were selected for review if they took place after the patient’s estimated time of HIV acquisition and before their eventual diagnosis. Charts were reviewed to determine whether HIV infection was suspected and whether testing was offered. Results Among a cohort of HIV-positive young adults, only 3 of 84 (3.6%; CI95 0.9 – 10.8) were seen in the PED during the time they were undiagnosed but likely to be infected with HIV. Among these subjects, there was no documentation that HIV testing was offered or refused, nor was there documented suspicion of HIV. Conclusions There are opportunities for earlier diagnosis of HIV in PEDs, affirming the importance of HIV screening implementation in these settings. However, PED’s are unlikely to have the same frequency of contact with undiagnosed individuals as do adult EDs. Alternative methods of accessing at-risk adolescent populations must be identified.