Kathy Tomaszewski

Integrating Pregnancy Prevention Into an HIV Counseling and Testing Program in Pediatric Primary Care

PURPOSE Certified health educator (CHE)-based HIV counseling and testing typically focus on HIV and sexually transmitted infection (STI) prevention only. A quality improvement initiative examined integrating assessment of reproductive life plans, counseling about pregnancy prevention, and contraception referral into a CHE-based HIV testing program. METHODS Between February 2014 and January 2017, in one urban pediatric primary care clinic serving patients aged 0-25, CHEs assessed sexual history, HIV risk, short-term (i.e., the next 6-12 months) pregnancy desire, and current contraception method and satisfaction among patients aged 13-25 who had ever had vaginal sex, using a standardized questionnaire. Data were analyzed using a de-identified administrative dataset that also tracked referrals to initiate contraception and actual method initiation. RESULTS Of 1,211 patients, most (96%) reported no short-term pregnancy or partner pregnancy desire. Use of less effective or no contraception, as well as method dissatisfaction, was common. A high proportion of female patients referred to new methods opted for more effective methods (62%) and initiated these methods (76%); a high proportion of male patients opted for receipt of condoms (67%). Patients reporting short-term pregnancy desire reported higher rates of previous pregnancy and STIs. CONCLUSIONS Program findings highlight the potential benefit of integrating assessment for and counseling about pregnancy prevention in a CHE-based HIV testing program. This can more effectively address the needs of patients with concomitant risks of STI/HIV and unintended pregnancy, and link patients who do not desire pregnancy to more effective methods.

A System-Level Approach to Improve HIV Screening in an Urban Pediatric Primary Care Setting

Rapid HIV screening in pediatric primary care can be used to improve the screening rate and result receipt in youth, one of the highest-risk populations. BACKGROUND AND OBJECTIVES: Less than 50% of youth living with HIV know their status. The Centers for Disease Control and Prevention and the United States Preventive Services Task Force recommend universal HIV screening in adolescence. Pediatric primary care settings are still lacking in testing youth who are at risk for HIV. Our objective was to determine whether implementing rapid HIV screening improved HIV screening rates and result receipt in 13- to 25-year-old pediatric primary patients. METHODS: From March 2014 to June 2015, a 4-cycle plan-do-study-act quality improvement model was used. A total of 4433 patients aged 13 to 25 years were eligible for HIV screening on the basis of Centers for Disease Control and Prevention criteria. Logistic regression with random effects was used to estimate the odds of HIV screening and screening with a rapid test compared with each previous cycle. Statistical process control charts using standard interpretation rules assessed the effect of patients receiving rapid HIV screening. RESULTS: Baseline HIV screening rate was 29.6%; it increased to 82.7% in cycle 4. The odds of HIV screening increased 31% between cycle 1 and baseline (odds ratio 1.31 [95% confidence interval: 1.01–1.69]) to a 1272% increase between cycle 4 and baseline (odds ratio 12.72 [95% confidence interval: 10.45–15.48]), with most (90.4%) via rapid screening. Rapid screening yielded higher same-day result receipt . Five patients were identified with HIV and immediately linked to on-site care. CONCLUSIONS: Rapid HIV screening and system-level modifications significantly increased screening rates and result receipt, revealing this to be an effective method to deliver HIV services to youth.

Why Didn’t You Text Me? Poststudy Trends From the DepoText Trial

Objective. To evaluate the longitudinal impact of a 9-month text message intervention on participant adherence beyond the intervention to highly effective contraceptive methods among urban adolescent and young adult women enrolled in the DepoText randomized control trial (RCT). Study Design. Retrospective longitudinal cohort study of long-term follow-up data from the DepoText RCT. Sixty-seven female participants (aged 13-21 years) using depot medroxyprogesterone acetate (DMPA) were recruited from an urban academic adolescent practice in Baltimore, Maryland. The principal outcome measured was a comparison of contraceptive method choice between the control and intervention groups during the 20 months postintervention. Results. Intervention participants were 3.65 times more likely to continue using DMPA or a more efficacious method at the 20-month postintervention evaluation (odds ratio 3.65, 95% CI 1.26-10.08; P = .015). Conclusion. Participation in the DepoText trial was associated with continued use of DMPA or a more effective contraceptive method almost 20 months after the intervention exposure ended.

O09.6 Integration of prep in an academic adolescent clinic & impact of prep use on sexually transmitted infection (STI) rates

Introduction US youth are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) significantly reduces the risk of HIV infection and may impact sexual risk. Clinics that serve adolescents are one site proposed in reaching sexually active youth. We sought to: 1) describe the integration of PrEP into an adolescent clinic; and 2) examine impact of PrEP use on sexually transmitted infection (STI) rates. Methods Over 6 months, we integrated PrEP program into current family planning (FP) and HIV testing programs in an urban adolescent clinic. Patient lists were reviewed daily to identify those eligible for HIV testing/FP. Each eligible youth was asked about awareness of and interest in PrEP. We reviewed each chart to examine the PrEP cascade including: awareness, receipt of information, referral and referral acceptance, and PrEP use. We then examined whether PrEP use impacted rates of STI, comparing proportion of youth on PrEP with an STI in the 6 months before and after PrEP. Results 234 youth were approached as part of the the HIV/FP program. The mean age was 17.7 (S.D. 3.0), 232 were black (99%), 101 were males (43%), 133 were females (57%), 2 transgender (1%), and 24 self-identified as lesbian, gay, or bisexual (LGB) (10%). Among the 234 youth seen, 17 (7.2%) were aware of PrEP, 49 (21%) received information, and 33 (14%) were referred for PrEP. Among those referred, 24 (73%) accepted referral and 15 (45%) initiated PrEP. Rates of STI decreased from 60% (n=9) at baseline/6 months prior to 13% in the 6 months after PrEP (p=0.02). Conclusions Few sexually active youth in this setting were aware of PrEP. Coupling HIV testing/FP with an assessment of interest in PrEP and referral to PrEP services may be one access point in increasing knowledge and use of PrEP.