St. Louis Children’s Hospital (SLCH) integrated HIV testing into routine patient care in July 2008. Since then, nearly 700 HIV tests have been performed in the emergency unit (EU), eight times the number of tests the previous year.
“The program has been successful and widely accepted by parents and patients in the EU,” says Jon McGreevy, SLCH pediatric emergency medicine fellow. “When approached, nearly 95 percent of adolescents agreed to the testing.”
Responding to a Centers for Disease Control and Prevention (CDC) recommendation that HIV testing be integrated into routine patient care and barriers to HIV testing be removed, SLCH was one of the first pediatric hospitals in the nation to establish a testing program. A rapid screening process using an oral swab produces results within 20 minutes. Positive results are confirmed with another serum rapid test as well as a Western blot.
Written information explaining the HIV testing is provided to teens age 15 and older and their parents or guardians in triage after they present to the emergency unit. Initially, patients meeting the age criteria were asked privately, separate from their parent or guardian, whether or not they wanted the test done.
“We found that we weren’t approaching as many patients as we should because it is understandably difficult to separate a parent from a child in the EU,” says Dr. McGreevy. “We have now changed our testing policy so that every adolescent age 15 or older will be approached – either privately or with their parent – and offered the HIV test. As always, patients have the option to refuse or opt-out of testing.”
Testing may now be done with parents in the room. All HIV test results are shared with teenage patients privately, ensuring confidentiality, unless they choose to have their parent(s) present. If the HIV test results are positive, patients decide which adult(s) in their lives they want informed about their HIV-positive status. EU staff then helps facilitate the patient’s disclosure to the adult. EU staff also aids in transitioning the teenager’s care to the Children’s Hospital pediatric HIV clinic. Test results are made available to the patient’s primary care provider in the EU visit summary report.
To contact Dr. McGreevy or Ericka Hayes, MD, attending infectious diseases physician and a member of Washington University’s pediatric/youth HIV specialty team, call Children’s Direct at 800.678.HELP (4357).