Factors affecting acceptance of routine human immunodeficiency virus screening by adolescents in pediatric emergency departments.
OBJECTIVE
Human immunodeficiency virus (HIV) screening in health care settings including emergency departments (EDs) is recommended for adolescents in the United States. This study aimed to evaluate the acceptance of and the factors affecting the HIV screening in pediatric EDs.


METHODS
A prospective, cross-sectional study of rapid opt-out oral HIV screening among adolescents ≥13 years of age was conducted in two pediatric EDs during 2009-2011. Descriptive statistics and logistic regression models were used to identify factors associated with the acceptance of HIV screening.


RESULTS
During 24 months, 8,519 adolescents were approached for HIV screening; 6,184 (72.6%) did not opt out, and of those 5,764 (93.2%) were tested for HIV. Most adolescents who accepted testing were black (80.5%), female (57.6%), aged 15-17 years (50.1%), and District of Columbia residents (67.7%), and were accompanied by a guardian (69.1%). Acceptance of HIV screening varied by age, race/ethnicity, and state of residence, with younger (<15 years) (adjusted odds ratio [aOR], 1.67; 95% confidence interval [CI], 1.33-2.09), non-black adolescents (aOR, .88; 95% CI, .77-.99) and non-District of Columbia residents (aOR, .86; 95% CI, .77-.96) being more likely to opt out of testing. Lower odds of opt-out of HIV testing were seen among adolescents with a guardian present (aOR, .42; 95% CI, .34-.53). The reasons for opt-out varied significantly by age and the presence of a guardian.


CONCLUSIONS
The patient's age and the presence of a guardian were significantly associated with adolescents' decision and reasons to opt out of HIV screening in pediatric EDs. Further studies are necessary to evaluate the interventions needed to increase routine ED HIV screening in adolescents.
Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC. Electronic address: nrakhman@childrensnational.org.
Natella
N
Rakhmanina
Center for Translational Science, Children's Research Institute, Washington, DC.
Nicole
N
Messenger
Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC.
Gregory
G
Phillips
Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Division of Allergy and Immunology, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.
Stephen
S
Teach
Division of Emergency Medicine, Children's National Medical Center, Washington, DC; Center for Translational Science, Children's Research Institute, Washington, DC; Department of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC.
Sephora
S
Morrison
Center for Translational Science, Children's Research Institute, Washington, DC.
Jaclyn
J
Hern
Center for Translational Science, Children's Research Institute, Washington, DC.
Jun
J
Payne
Center for Translational Science, Children's Research Institute, Washington, DC.
Kavitha
K
Ganesan
Division of Infectious Diseases, Children's National Medical Center, Washington, DC; Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC.
Amanda D
AD
Castel
D015492:AIDS Serodiagnosis; D000293:Adolescent; D003430:Cross-Sectional Studies; D004219:District of Columbia; D004636:Emergency Service, Hospital; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D057828:Informed Consent By Minors; D016015:Logistic Models; D008297:Male; D010342:Patient Acceptance of Health Care / Q000208:ethnology / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014505:Urban Population; D055815:Young Adult
Adolescents; Emergency department; HIV; Routine screening