HIV Testing in Adolescents and Young Adults Receiving STI Testing in an Urban Primary Care Setting

Abstract

IN THE UNITED STATES, an estimated 1 million people are infected with the humanimmunodeficiency virus (HIV) and one-quarter are unaware of their infection. 1 Rates of newinfections have increased among young persons with nearly half of all new HIV infections inthe US occurring in black adolescents and young adults aged 13 to 24.1-4Despite evidence that early diagnosis may have potential advantages in promoting prevention,5-8 improving immune restoration, and linking HIV-infected persons with care9 HIV testinghas been a controversial and difficult area to define and produce relevant guidelines. In 2001,the Centers for Disease Control and Prevention 10 (CDC) recommended universal HIV testingfor all persons who (a) live in communities with an HIV prevalence >1%; (b) have known riskfactors for HIV infection; and (c) request HIV testing. In September 2006, the guidelines forhealth care settings were modified to recommend that all persons aged 13 to 64 years be testedfor HIV.11Understanding risk-based care delivery patterns of providers who care for vulnerablepopulations is salient to understanding the acceptance of the current guidelines. The purposeof this study was to determine if care-seeking adolescents and young adults who were receivingsexually transmitted infection (STI) testing and living in a high-HIV–prevalent communitywere being tested for HIV according to CDC guidelines.To select adolescents who fall in the special CDC risk categories, medical records ofadolescents and young adults aged 11 to 24 years who were evaluated for an STI in a largeacademic ambulatory care facility in Baltimore, MD, between July 2003 and June 2004 werereviewed. This time frame was used to include time points in all seasons. This multidisciplinarypractice provides general pediatric care, adolescent medicine primary and subspecialty care,and HIV primary and specialty care as a 3-team structure. Most of the patients served by thisclinic are from the Baltimore metropolitan area. Baltimore is a large city on the east coast ofthe United States that is 64% black, has 23% of the population living below poverty level,12and an estimated community HIV incidence of 166.8 per 100,000 persons.13 The clinic isprimarily staffed by resident, fellow, and nurse practitioner providers supervised by attendingphysicians. Counselors are also available on-site to provide pre/posttest HIV counseling andgeneral STI/HIV risk reduction counseling to adolescents.Quality assurance (QA) laboratory logs were used to randomly identify patients who had STIand/or HIV testing during the study period. Inclusion criteria for chart review included (a) agebetween 11 and 24 years and (b) evidence of STI screening or testing at the visit during the