Expanding knowledge of HIV status among youth by implementing rapid testing in an adolescent / young adult clinic

Background: Risk-based HIV testing is inadequate for youth, but adolescents have unique barriers to clinic-based testing. The CDC now recommends routine, opt-out HIV screening for all persons ages 13-64, with annual testing for high-risk individuals. Nevertheless, half of all infected adolescents are unaware of their status and only 59-65% of tested youth return for results. Rapid testing (RT) may help sexually-active adolescents overcome barriers to knowledge-of-status. Methods: To improve return rates and assess attitudes towards testing, we conducted a pilot project rolling out free RT at an urban, hospital-based Adolescent/Young Adult Clinic with a nested on-site HIV program. During the 16-week pilot, we tracked clinician-ordered blood tests (CT) at clinic visits, and grant funded tests: 1/ oral or blood (2-week) tests; or 2/ finger-stick RT (20-minutes) through our HIV program. A 23-item anonymous survey assessed testing attitudes and barriers, while retrospective record reviews evaluated demographic characteristics, risk behaviors, test results and return rates. Results: Weekly tests increased by 58%. Of 175 total tests, few (6.9%) were CT, 20.6% free 2-week tests, and 72.6% RT (1.6% seropositive). RT and confirmatory test return rates were 100%. Survey analysis (N=131) revealed strong support for confidential RT. While 31% preferred free testing, 58% expressed willingness to pay a portion (³$10) of testing product costs. This paper will analyze associations among test methods, youth characteristics and testing attitudes/behaviors. Conclusions: This study demonstrated dramatic testing and return-rate improvements in an adolescent setting offering rapid HIV testing. The survey results suggest feasible approaches for similar programs.