181234 Expanding knowledge of HIV status among youth by implementing rapid testing in an adolescent / young adult clinic

Monday, October 27, 2008

Cathryn L. Samples, MD, MPH , Division of Adolescent / Young Adult Medicine, Children's Hospital Boston, Boston, MA
Selin Tuysuzoglu, BA , Student; Joint M.D/Masters of Public Health Program (06/09), Harvard School of Public Health / Albert Einstein College of Medicine, Boston, MA
Brian R. Abascal, MFA , Division of Adolescent / Young Adult Medicine, Children's Hospital Boston, Boston, MA
Heather L. Corliss, MPH, PhD , Adolescent Medicine, Children's Hospital Boston, Boston, MA
Adam J. Beitscher, BA , Boston HAPPENS Program, Adolescent Medicine, Children's Hospital, Boston, MA
Susan M. Fitzgerald, MSN, CPNP , Division of Adolescent / Young Adult Medicine, Children's Hospital Boston, Boston, MA
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.

Learning Objectives:
1. Evaluate the impact of open access RT on adolescent/young adult HIV testing attitudes and behaviors. 2. List barriers and facilitators to implementing the 2006 CDC testing guidelines among urban youth. 3. Assess the feasibility of integrating RT in youth-specific settings without grant funding.

Keywords: HIV/AIDS, Adolescent Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a manager of publicly funded community and hospital-based HIV testing programs, and Clinical Director of a program providing HIV prevention, case finding,care and support to at risk urban youth for 15 years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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