Pediatricians should offer routine HIV testing to adolescent and young adult patients, American Academy of Pediatrics recommends in academy’s new policy statement published November print issue of Pediatrics.
In light of the increasing numbers of people with HIV/AIDS and missed opportunities for HIV testing, the Centers for Disease Control and Prevention…recommends universal and routine HIV screening rather than targeted testing.
- When HIV prevalence in the patient population exceeds 0.1%, all adolescents should be offered routine HIV screening at least once by 16 to 18 years of age.
- In areas where HIV prevalence in the community is lower, all sexually active adolescents and those with substance use or other risk factors for HIV should have routine HIV testing.
- Annual HIV testing is recommended for high-risk youth, and adolescents undergoing testing for other sexually transmitted infections (STIs) should be tested for HIV at the same visit.
- Routine HIV testing should be implemented in emergency departments and urgent care facilities in high-prevalence areas.
- Physicians should be aware of the symptoms of acute retroviral syndrome and consider HIV RNA testing for viral load in youth with appropriate risk factors.
- Adolescent consent should suffice for testing and treatment for HIV infection or STIs, although parental involvement is always desirable. If there are cost or confidentiality issues, free and confidential community-based testing programs are available.
- Regardless of perceived risk, pediatricians should routinely ask adolescents about sexual and substance use behaviors, ideally using standardized assessment tools and a confidentiality protocol.
- Pediatricians should foster an environment of tolerance to facilitate frank, nonjudgmental discussion of gender and sexual orientation.
- If permitted by state laws, opt-out HIV testing is preferred. Rapid HIV testing offers immediate preliminary results and is similarly sensitive to enzyme immunoassays. If routine HIV opt-out testing in adolescents is not permitted by state laws, physicians are encouraged to advocate for change.
- To reduce future risk, adolescents with a negative HIV test result should be counseled regarding sexual and drug use behaviors.
- Adolescents with a positive HIV test result should be referred to age-appropriate HIV specialty care, including prenatal care if needed.
- Pediatricians are encouraged to advocate for prevention education and access to confidential HIV and STI testing for adolescents, in addition to counseling and HIV treatment.
- Preventive care screening should include universal coverage and sufficient reimbursement for HIV testing and related counseling. Physicians should advocate for confidential billing practices for HIV and STI testing in adolescents and young adults.