Point-of-care saliva testing raised HIV screening rate at adolescent clinic
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Key takeaways:
- Point-of-care saliva testing can detect HIV in 20 minutes.
- HIV testing rates jumped from 12% to 55% at a clinic offering point-of-care saliva testing.
TORONTO — An adolescent medicine clinic more than quadrupled its HIV screening rate by offering point-of-care saliva testing, according to findings presented at the Pediatric Academic Societies Meeting.
The oral tests helped some patients overcome fears of having their blood drawn, researchers reported. The intervention also included educating residents and providers about recommendations for HIV screening.
According to J. Blakely Amati, MD, FAAP, medical director of the Prisma Health Bradshaw Institute for Community Child Health and Advocacy and clinical assistant professor at University of South Carolina School of Medicine Greenville, the latest CDC data from 2018 show that 35% of adolescents aged 13 to 24 years with HIV do not realize they have it.
“When looking at HIV care across the U.S., in comparison to adults, youth with HIV are less likely to have received some HIV care, be retained in care and be virally suppressed,” Amati told Healio.
In 2021, the AAP updated its HIV screening guidelines to recommend that all patients aged 15 years or older be screened at least once, regardless of history of sexual activity and/or other high-risk behaviors or local prevalence rates.
Amati and colleagues began their work by trying to determine why universal HIV screening rates are so low, and found reasons involving a fear of needles or blood draw, delayed results, and communicating test results.
“Our adolescent medicine clinic had recently implemented use of the CLIA-waived point-of-care OraQuick, an oral swab that detects antibodies to HIV-1 and HIV-2 with a sensitivity of 99.3% and a specificity of 99.8%, with test results in 20 minutes,” Amati said. “We were able to adapt lessons learned from our adolescent clinic to build a swim lane diagram of workflow for our clinic.”
The researchers adapted patient counseling, educational materials and workflow tips from a manual created by HHS’s Health Resources and Services Administration. Teenage patients also received printed information about screening and were given the option of checking “yes,” “no,” or “speak to provider” on a handout prior to their appointment. If the patient agreed to testing, an oral swab was collected before the visit and before they were asked about their sexual history.
“When teens elicit high-risk sexual behaviors during the interview, we are then able to send them to collect urine for gonorrhea and chlamydia and to our lab for fingerstick syphilis testing,” Amati said.
The median rate of HIV screening for adolescents aged 16 through 18 years at the practice was 12% from 2017 to 2021 and climbed to 55% after February 2023.
Amati said the clinic is interested in examining overall testing rates, since data for this presentation were based on random chart audits.
“We want to continue to ensure that other sexually transmitted infection testing does not decrease with our new process,” Amati said. “Studies I would like to see more broadly on this would be HIV POC testing out in community/neighborhood settings, as well as at-home testing.”
“It is critical that all teens know their HIV status, regardless of risk-based behaviors or local prevalence rates,” Amati continued. “Early detection allows for earlier treatment and helps prevent spread of the virus and will ultimately be the way to end the HIV epidemic.”
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Amati JB, et al. Status update: Increasing universal HIV screening with clinic point-of-care testing. Presented at: Pediatric Academic Societies Meeting; May 2-6, 2024; Toronto.
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