Missed Opportunities for Diagnosis of Non-Perinatally Acquired HIV in Adolescents: A Retrospective Chart Review

Background: More than 1.1 million people are living with HIV in the U.S., and an estimated 20-25% of those are unaware of their infection. Up to 25% of new HIV infections in the U.S. each year occur in persons age 13-24 years. Early detection may decrease HIV transmission, morbidity, and mortality. Medical literature has revealed a high rate of missed opportunities in diagnosing HIV infection in adults, yet there remains a dearth of this information in adolescents. Objectives: This study evaluates the impact of the 2006 CDC recommendations for routine HIV screening and the problem of missed opportunities for diagnosis of non-perinatally acquired HIV infections in adolescents. This study aims to determine a link between demographic and clinical characteristics and missed opportunities for HIV testing. Methods: Reviewed medical records of patients at the Dorothy Mann Center for Pediatric & Adolescent HIV Program at St. Christopher’s Hospital for Children to obtain demographic and clinical data for healthcare encounters prior to HIV clinical care intake. Descriptive and regression statistics were used to determine correlations between characteristics and potential missed opportunities. Results: Participants were primarily black, male, and insured through Medicaid. Subjects had an average of 2.74 prior healthcare encounters with possible signs of HIV identified. Regressions of the outcome variables for previous encounters revealed statistically significant associations for age & race, with blacks & Hispanics having fewer encounters and each 1-year increase of age resulting in an increase of encounters. Regressions for number of days from diagnosis to intake & CD4 count at clinic intake both yielded non-statistically significant results. These models, however, did associate females with more days from diagnosis to intake than males, and each 1-year increase of age was associated with an increase in CD4 count. Conclusions: Observed associations may be due to the small sample size (n=27), which included a few individuals with extreme values for some of the variables. Pediatric providers need to be more aware of HIV signs and testing recommendations. Further pediatric HIV studies should be conducted in Philadelphia and on the national level so that results may be compared to these results.M.P.H., Public Health -- Drexel University, 201