The Potential Impact of One-Time Routine HIV Screening on Prevention and Clinical Outcomes in the United States

Most sexually active youth in the United States do not believe that they are at risk for contracting HIV and have never been tested. Creating safe environments that promote confidentiality and respect, obtaining an accurate sexual and reproductive health assessment, and providing nonstigmatizing risk counseling are key components of any youth encounters. Pediatricians can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing and prophylaxis to adolescent and young adult (youth) patients. In light of persistently high numbers of people living with HIV in the United States and documented missed opportunities for HIV testing, the Centers for Disease Control and Prevention and the US Preventive Services Task Force recommend universal and routine HIV screening among US populations, including youth. Recent advances in HIV diagnostics, treatment, and prevention help support this recommendation. This clinical report reviews epidemiological data and recommends that routine HIV screening be offered to all youth 15 years or older, at least once, in health care settings. After initial screening, youth at increased risk, including those who are sexually active, should be rescreened at least annually, and potentially as frequently as every 3 to 6 months if at high risk (male youth reporting male sexual contact, active injection drug users, transgender youth; youth having sexual partners who are HIV-infected, of both genders, or injection drug users; youth exchanging sex for drugs or money; or youth who have had a diagnosis of or have requested testing for other sexually transmitted infections). Youth at substantial risk for HIV acquisition should be routinely offered HIV preexposure prophylaxis, and HIV postexposure prophylaxis is also indicated after high-risk exposures. This clinical report also addresses consent, confidentiality, and coverage issues that pediatricians face in promoting routine HIV testing and HIV prophylaxis for their patients.

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Routine HIV Screening as a Standard of Care: Implementing HIV Screening in General Medical Settings, 2013-2015

Public Health Reports ◽

10.1177/0033354918801833 ◽

2018 ◽

Vol 133 (2_suppl) ◽

pp. 52S-59S ◽

Cited By ~ 2

Author(s):

Laura Roche ◽

Saul Zepeda ◽

Blair Harvey ◽

Karen A. Reitan ◽

Raekiela D. Taylor

Keyword(s):

United States ◽

Health Care ◽

Electronic Health Records ◽

Capacity Building ◽

Standard Of Care ◽

The United States ◽

Hiv Screening ◽

Health Records ◽

Medical Settings ◽

Routine Hiv Screening

Objective: We implemented routine HIV screening as part of the 4-year Care and Prevention in the United States Demonstration Project, whose aim was to reduce HIV/AIDS–related morbidity and mortality among racial/ethnic minority groups in the United States. We describe the capacity-building efforts to implement routine HIV screening and provide lessons learned and implications for practice. Methods: From January 2013 through September 2015, the Public Health Institute of Metropolitan Chicago (PHIMC) implemented routine HIV screening in 7 health care systems in Illinois by providing capacity-building assistance focused on systems and operational infrastructure, staff member skills and organizational structure, and clinic culture. Each site received funding to integrate routine HIV screening into the existing clinic flow, engage the entire health care team in the process, and transform the system and shift clinic culture to sustain HIV screening. Results: All 7 systems established policies and procedures to implement routine screening, 5 systems integrated HIV test ordering and documentation into their electronic health records, and 4 systems established a third-party billing and reimbursement process for testing. The 7 systems conducted a total of 49 285 tests and identified 160 people living with HIV. The number of tests increased by more than 40% each year. Conclusions: PHIMC identified the following practices for consideration when implementing routine HIV screening in general medical settings: create a culture that supports HIV screening, use champions in clinics, integrate HIV screening into clinic flow and electronic health records, and train clinic staff members on HIV messaging. Incorporating these practices can help other clinical settings build capacity to make routine HIV screening a standard of care.

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Expanded HIV Screening in the United States: Effect on Clinical Outcomes, HIV Transmission, and Costs

Annals of Internal Medicine ◽

10.7326/0003-4819-145-11-200612050-00004 ◽

2006 ◽

Vol 145 (11) ◽

pp. 797 ◽

Cited By ~ 127

Author(s):

A. David Paltiel ◽

Rochelle P. Walensky ◽

Bruce R. Schackman ◽

George R. Seage ◽

Lauren M. Mercincavage ◽

...

Keyword(s):

United States ◽

Clinical Outcomes ◽

Hiv Transmission ◽

The United States ◽

Hiv Screening

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Faculty Opinions recommendation of Recent trends in clinical outcomes and resource utilization for pulmonary embolism in the United States: findings from the nationwide inpatient sample.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1161903.623526 ◽

2009 ◽

Author(s):

Imre Noth

Keyword(s):

United States ◽

Pulmonary Embolism ◽

Clinical Outcomes ◽

Resource Utilization ◽

Nationwide Inpatient Sample ◽

The United States ◽

Recent Trends

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Faculty Opinions recommendation of Age-related differences in clinical outcomes for acute asthma in the United States, 2006-2008.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.14029956.15487056 ◽

2012 ◽

Author(s):

Gregory Hawkins ◽

Rebecca Slager

Keyword(s):

United States ◽

Clinical Outcomes ◽

Acute Asthma ◽

The United States ◽

Age Related

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Greensboro and Beyond: Remediating the Structural Sexism in Truth and Reconciliation Processes and Determining the Potential Impact and Benefits of Truth Processes in the United States

Feminist Perspectives on Transitional Justice ◽

10.1017/9781839700682.013 ◽

2013 ◽

pp. 215-254

Author(s):

Peggy Maisel

Keyword(s):

United States ◽

The United States ◽

Truth And Reconciliation ◽

Potential Impact

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A scoping review of female drowning: an underexplored issue in five high-income countries

BMC Public Health ◽

10.1186/s12889-021-10920-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Kym Roberts ◽

Ogilvie Thom ◽

Susan Devine ◽

Peter A. Leggat ◽

Amy E. Peden ◽

...

Keyword(s):

United States ◽

Risk Factors ◽

United Kingdom ◽

New Zealand ◽

Clinical Outcomes ◽

Scoping Review ◽

The United States ◽

Clinical Treatment ◽

High Income ◽

Public Health Issue

Abstract Background Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning. Methods A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines. Results The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females). Conclusion Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

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