Why is St. Louis Children’s Hospital testing for HIV?
The Centers for Disease Control has recommended testing all patients 13-65 years for HIV at all healthcare visits. This is especially true for patients that visit an Emergency Department as the population is more at risk. Also, St. Louis has some the highest rates for sexually transmitted infections when compared to other U.S. cities.
STD Statistics for U.S. Adolescents and Young Adults:
- Have the highest rates of sexually transmitted diseases (STDs)
- Contract 10 million sexually transmitted infections (STIs) annually, 50% of the total STDs
- 15-19 year olds and 20-24 year olds are the leading age groups
- Account for 50% of the 40,000 new HIV infections occurring annually
- The only age groups in which HIV rates have continued to rise
- By graduation from high school, 1 in 2 U.S. teenagers is sexually active
Saint Louis City sexually transmitted diseases statistics:
- Gonorrhea rates are 7 times the national average
- Chlamydia rates are 4 times the national average
- Syphilis rates are 3 times the national average
HIV Testing Frequently Asked Questions...
My child is being seen in the __________ clinic, will they be tested?
At this time, only patients being seen in the Emergency Department of St. Louis Children’s Hospital will be offered the rapid screen test for HIV.
Are you testing every patient for HIV?
Only patients older than 15 years of age who are competent to give consent will be offered the screening test for HIV. Testing will be done if the teenager says it is okay. No one will be forced to be tested.
Who are you testing for HIV?
All patients older than 15 years of age who are competent to give consent for the test themselves who present to the ED for any complaint or reason.
I do not want my child tested for HIV. Will you still offer them testing?
Your adolescent will likely still be offered the HIV screening test, as Missouri State Law gives the adolescent the right to consent for any healthcare services related to pregnancy, sexually transmitted infections and alcohol or drug abuse.
Your teenager will receive the pamphlet in triage explaining our testing program. It is the teenager’s decision to decide if they do or do not want to be tested, not the parents. However, if we are unable to offer the teenager privacy in testing, we will not offer the test as that is a disservice to the teenager and a violation of their right to confidentiality of HIV testing.
Who gets the results of the HIV test?
The patient that consented for the HIV screening test will get the results. However, if an adolescent is comfortable with their parent or guardian present to be included in sharing of the results, then the wishes of the adolescent will be accommodated.
Why, as the parent, do I not get the test results?
Missouri State Law is very clear and specific about who is entitled to knowledge of HIV results. These laws preserve the confidentiality of the patient and thus turn the power of disclosure to the patient.
How can I get the test results?
Parent: The only way to obtain test results for HIV screening is through the consent or disclosure by your adolescent. Medical staff and medical records are bound by the law to keep HIV testing results confidential without the permission of the patient.
Patient: HIV screening tests performed in the Emergency Department will have results in 20-40 minutes and be given to you before the conclusion of the visit.
Where can we have an HIV test performed?
Is this test charged to my insurance?
The HIV screening test is currently free of charge and it will not be billed to you or your insurance provider.
Do the results of this test change my care?
A positive or negative HIV test will not change the way any patient is treated within the Emergency Department.
Does refusal of the rapid HIV screening test change my care?
No, you or your adolescent will still be seen in the Emergency Department and treated normally for whatever condition made you seek Emergency Department services.
Are the results confidential?
We will keep all results of HIV tests, positive or negative, confidential with the patient. However, HIV like other sexually transmitted infections has to be reported to the local Health Department.
Is this anonymous testing?
This is not an anonymous testing facility.
Can I get the HIV test without being seen in the emergency room?
What happens if the teen’s oral test is positive? Does it mean they have HIV?
If the oral rapid HIV test is positive, confirmatory testing needs to be performed. The confirmatory testing includes a second rapid test using a blood specimen and a Western Blot (the gold standard for diagnosis). The second rapid test will yield a result in 20-40 minutes. Two positive tests will be considered a new diagnosis of HIV and have follow-up with the HIV clinic on the Monday afternoon following the diagnosis. Discordant tests with the blood rapid screen being negative will be considered a false positive; these patients will also have a follow-up in the HIV clinic on the Monday afternoon following the diagnosis to reassure and confirm the results of the Western Blot.
What is the sensitivity, specificity and positive predictive value of the rapid HIV test?
Oral specimens have a sensitivity of 99.3 (95% CI 98.4 - 99.7) and a specificity of 99.8 (95%CI 99.6 – 99.9). Blood specimens have a sensitivity of 99.6 (95% CI 98.5 - 99.9) and a specificity of 100 (95% CI 99.7-100). The positive predictive value (PPV) of the test is directly related to the incidence of HIV. The minimum incidence of HIV to have a screening program is 0.1% and with this test the PPV of a single oral test would be 50%; this means that half of the positive oral tests will be true positives and half will be false positives. The incidence of adolescent HIV in St. Louis is likely between 0.3% and 0.5% which would increase the PPV of a single oral test to 70-85%; this would mean that approximately 3 out of every 4 positive oral tests will be true positives and that 1 will be a false positive.
Due to the unknown true incidence of adolescent HIV in St. Louis, we have decided to backup all positive oral swabs with a rapid blood specimen. This will change the PPV to virtually 100%.
Why are you using the oral rapid test?
The oral test is being used because it is less invasive and thus more likely to be accepted.
What rapid test are you using?
We have chosen to use the Oraquick Advance that detects HIV-1 and HIV-2. The reasons to use this particular test are several. The same testing kit can be used for both oral and blood specimens. It has a rapid time to result of 20 minutes and another 20 minute reading time window. This particular test has been CLIA waved as well.
How can you get HIV?
HIV is primarily found in the blood, semen, or vaginal fluid of an infected person, Thus, HIV is most often spread through sex (anal, vaginal, or oral) with someone infected with HIV. Additionally, sharing needles and syringes with someone infected with HIV can lead to the spread of HIV.
How can you protect yourself from getting HIV?
- Abstain from sex
- Use a protective barrier, like a condom
- Do not share needles for injection drugs
- Maintain a mutually monogamous relationship with your partner
How often should teens be tested for HIV?
The Centers for Disease Control recommend annual testing as a part of routine health maintenance.
- Doctors should test all persons likely to be at high risk for HIV at least annually. Persons likely to be at high risk include injection-drug users and their sex partners, persons who exchange se for money or drugs, sex partners of HIV-infected persons, and men who have sex with men (MSM) or heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test.
- Doctors should encourage patients and their prospective sex partners to be tested before initiating a new sexual relationship.
- Repeat screening of persons not likely to be at high risk for HIV should be performed on the basis of clinical judgment