Table 1 Pediatric emergency department HIV screening studies data summary

April 1995—March 1997

Milwaukee, WI

75,000

Voluntary

Opt-in

Written Consent

No parental consent > 13 years

Phlebotomized samples for ELISA

Western blot

ED nurse

Program improvement initiative; follow-up pre- vs. post-program intervention evaluated

November 2003—May 2004

Boston, MA

25,000

Voluntary

Opt-in

Written Consent > 18 years

Assent & parent/ guardian permission for 15–17 years

OraSure (Orasure Technologies, Inc.) oral fluid sampling; Testing performed by state laboratory after the patient visit

Western blot

Mondays-Fridays, noon-10 pm

One research assistant

September 2003—August 2006

Philadelphia, PA

70,000

Voluntary

Opt-in

Verbal consent for sexual health counseling; written consent for HIV testing

Not required per state law

OraSure (Orasure Technologies, Inc.) oral fluid sampling; Testing performed by an offsite laboratory

32 h/week

Health Educator

Program primarily provided sexual health counseling (30 min); testing offered after counseling. Patients presenting with possible sexually transmitted diseases and those referred by ED providers received priority for counseling

March 2008—October 2008

Memphis, TN

90,000

Implied

Opt-out

General consent & information sheet on HIV

Oraquick Advance Rapid HIV Antibody 1/2 test (OraSure Technologies, Inc) using oral fluid sampling

Western blot

Nurses

October 2009—December 2009

Newark, NJ

35,000

Voluntary

Opt-in

Written Consent

Clearview HIV 1/2 STAT-PAK (Chembio Diagnostics Systems, Inc.) rapid HIV fingerstick testing

Western blot

Every day, 24 h / day

Offer testing: PED clinical providers and department of health HIV counselors; Perform testing: HIV counselors

March 2009-February 2011

Washington, DC

126,000 combined (2 PEDs)

Voluntary

Opt-out

Verbal consent

Oraquick Advance Rapid HIV 1/2 Antibody Test (OraSure Technologies, Inc.) using oral fluid sampling

Western blot

Grant-funded personnel at ED1 and ED personnel at ED2 performed testing

January 2012-December 2016

Cincinnati, OH

89,000

Voluntary

Opt-out

Verbal consent

Oraquick Advance Rapid HIV 1/2 Antibody Test (OraSure Technologies, Inc) using oral fluid sampling

4^th generation antigen/antibody testing

Every day, 24 h / day

PED clinical providers

June 2019-October 2019

Atlanta, GA

60,000

Voluntary

Opt-out

Verbal consent

Architect HIV Ag/Ab Combo Test (Abbott Laboratories, Inc.); Fingerstick or phlebotomy sampling

40–60 h per week

Study investigators

April 1995—March 1997

Milwaukee, WI

75,000

ED nurse was responsible for arranging follow-up of HIV test results

12–18 years old

Targeted: presenting for possible STD

Pre-program: 490 STD visits;

Post-program: 372 STD visits

Pre-program: 18% HIV tested

Post-program: 27% HIV testing

4 ELISA positive HIV tests; 3 indeterminate and 1 negative Western blot

Pre-program:8.1% notified of HIV test results

Post-program: 57% notified of test results

2

November 2003—May 2004

Boston, MA

25,000

Follow-up of testing results was scheduled two weeks post-testing at an urgent care facility. The appointments of those who did not follow-up were not rescheduled

15–21 years old

Nontargeted

Tested for sexually transmitted diseases/HIV in past month; known HIV-positive status; non English- or Spanish-speaking; critically ill; intoxicated or presented with a psychiatric illness; university students or hospital employees; receiving care in common (open, less private) treatment areas of the ED; report being not “sexually experienced” if 15–17 years-old; presented to ED solely for HIV testing

1,749 Age-eligible; 1,202 Approached

791

765 Offered (96.7%)

464 Accepted (60.7%)

459

1 (0.2%)

1

September 2003—August 2006

Philadelphia, PA

70,000

Test results given within two weeks at a follow-up appointment

14–24 years old

Nontargeted

Victims of child abuse; “significantly developmentally delayed”; medically “unstable” per ED treatment team

32,121

1,287 Offered counseling (4%)

318 Accepted HIV testing and Tested (49.4%) (643 Accepted counseling (50.0%))

2 (0.6%)

2

March 2008—October 2008

Memphis, TN

90,000

Follow-up for testing appointment given 7–10 days post-testing at an adolescent HIV clinic

13–18 years old

Nontargeted

Critically-ill or injured

5,399

2,002 Approached (37.1%)

1,735 Accepted and Tested (86.7%)

1 (0.06%)

1

October 2009—December 2009

Newark, NJ

35,000

13–20 years old

Nontargeted

Critically ill; altered mental status; tested for HIV within past 3 months

2,645

300 Offered (11.3%)

224 Accepted (74.7%)

213

0 (0.0%)

NA

March 2009-February 2011

Washington, DC

126,000 combined (2 PEDs)

Patients whose rapid HIV test was positive received individual counseling with the case manager in the ED and a follow-up appointment 48–72 h after their PED visit at the specialized adolescent HIV services in the same medical center

13–24 years old

Nontargeted

Documented HIV test in the ED within the past six months (unless identified as high-risk)

8,528

8,519 (visits) Offered (77.5%)

6,184 Accepted (72.6%)

5,764

12

8 (.14%)

8

January 2012-December 2016

Cincinnati, OH

89,000

Patients ≤ 18 years old were scheduled to follow up in 7–10 days at the HIV clinic or primary care, and patients older than 18 years old were scheduled for a follow-up at the adult HIV clinic

Targeted: presenting for possible STD

Denied ever being sexually active or were being evaluated for concerns of sexual assault/abuse

4,378 Offered

14

11 (0.25%)

8 newly positive; 3 previously positive

11

June 2019-October 2019

Atlanta, GA

60,000

13–18 years old

Critically ill; unable to consent due to developmental delays or impaired mental status; deemed ineligible by their attending provider; previously diagnosed with HIV

1,307

1,061

806 Offered (76%)

344 Accepted (42.7%)

1 (0.3%)

1