Clinician adherence to recommendations for screening of adolescents for sexual activity and sexually transmitted infection/human immunodeficiency virus.
OBJECTIVE
To evaluate clinician adherence to guidelines for documentation of sexual history and screening for sexually transmitted infection (STI)/HIV infection during routine adolescent well visits. Secondary objectives were to determine patient and clinician factors associated with sexual history documentation and STI/HIV testing.


METHODS
Retrospective, cross-sectional study of 1000 randomly selected 13- to 19-year-old routine well visits at all 29 pediatric primary care practices affiliated with a children's hospital. We evaluated frequency of documentation of sexual history and testing for gonorrhea (GC)/chlamydia (CT) and HIV testing. Multivariable logistic regression was performed to identify factors associated with documentation and testing.


RESULTS
Of the 1000 patient visits reviewed, 212 (21.2%; 95% CI, 18.7-23.7) had a documented sexual history, of which 45 adolescents' (21.2%; 95% CI, 15.7-26.8) encounters were documented as being sexually active. Overall, 26 (2.6%; 95% CI, 1.6-3.6) patients were tested for GC/CT and 16 (1.6%; 95% CI, 0.8-2.4) were tested for HIV infection. In multivariable analyses, factors associated with sexual history documentation included older patient age, non-Hispanic black race/ethnicity, nonprivate insurance status, and care by female clinician. Factors associated with GC/CT testing included male gender, non-Hispanic black race/ethnicity, and nonprivate insurance. HIV testing was more likely to be performed on older adolescents, those of non-Hispanic black race/ethnicity, and those with nonprivate insurance.


CONCLUSIONS
Pediatric primary care clinicians infrequently document sexual histories and perform STI and HIV testing on adolescent patients. Future studies should investigate provider beliefs, clinical decision-making principles, and perceived barriers to improve the sexual health care of adolescents and evaluate interventions to increase rates of adolescent sexual health screening.
Children's National Medical Center, Washington, DC; Department of Pediatrics, The George Washington University, Washington, DC. Electronic address: mgoyal@cnmc.org.
Monika K
MK
Goyal
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Rachel
R
Witt
Children's Hospital of Philadelphia, Philadelphia, PA.
Katie L
KL
Hayes
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Children's Hospital of Philadelphia, Philadelphia, PA.
Theoklis E
TE
Zaoutis
Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Children's Hospital of Philadelphia, Philadelphia, PA.
Jeffrey S
JS
Gerber
D000293:Adolescent; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D017410:Practice Guidelines as Topic; D011320:Primary Health Care; D012189:Retrospective Studies; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000175:diagnosis*; D055815:Young Adult