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48: HIV testing in adolescents receiving STI services in an urban primary care setting
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Abstracts / 38 (2006) 137–163
Results: Participants were young (mean age⫽19.2 years), single (92.0%), diverse (44.1% non-Caucasian), and sexually experienced (85.4%). The prevalence rate of CT at T1 was 14.0%. At follow-up, the infection rates were 25 (3.9%), 64 (9.9%), and 65 (10.0%) at T2, during the interim period, and T3, respectively. Accounting for overlap in diagnoses of the same individuals between the T3 interim period and the T3 biological tests, the overall acquisition rate for CT during the one-year follow-up period was 20.0%. Conclusions: CT is prevalent among women entering recruit training for the Marine Corps, suggesting the need for universal screening for CT among women entering military service. CT acquisition rates at T2 (3.9%), T3 (10.0%) and by self-report (9.9%) were also high, demonstrating the importance of more frequent CT screening of all sexually active women and provision of intensive preventive health care services for all women in the armed forces. Support: Department of Defense, U.S. Army Medical Research and Material Command, Fort Detrick, MD, and the Maternal and Child Health Leadership Education in Adolescent Health.
Results: Of the 150 adolescents, 81% were female, 93% were African American, and 76% had insurance. Mean age of males and females was 17 years old. Fifty-four percent of patients were tested for HIV. Each variable of interest was associated with HIV testing on univariate analysis and contributed to the logistic regression model at p ⬍0.05. Predictor Variable STI at the visit Hx. of STI Provider (resident, fellow, nurse) # of Current partners (0, 1, ⬎1) Risk Reduction Counseling
OR
AOR (95%CI)
2.8 (1.4-5.6) 2.2 (1.1-4.4) 1.8 (1.1-3.2) 3.9 (1.4-10.7) 2.6 (1.2-5.7)
2.7 (1.2-6.7) 1.6 (0.7-3.9) 2.5 (1.2-5.3) 3.6 (1.3-10.0) 1.6 (0.6-4.3)
Conclusion: More than half of patients screened for STIs in this academic primary care practice were also screened for HIV. Testing appears to be associated with risk-assessments by providers, diagnosis at the visit, and provider type. Due to the high prevalence of HIV infection in this community and the potential for missed cases due to risk-category misclassification, further quality improvement efforts that increase patient acceptance of HIV testing and provider adherence to the recommendation for universal counseling and testing are indicated.
48. HIV TESTING IN ADOLESCENTS RECEIVING STI SERVICES IN AN URBAN PRIMARY CARE SETTING Renata Arrington-Sanders, MD, MPH, Jonathan Ellen, MD, Maria Trent, MD, MPH. Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Purpose: Up to 30 000 to 100 000 adolescents younger than 25 years old are infected with HIV and 25% are unaware of their status. The Centers for Disease Control and Prevention recommends that universal HIV counseling, testing and referral (CTR) be provided by primary care physicians to all clients in settings serving client populations with lifestyle behaviors that predispose them to increased risk (regardless of setting HIV prevalence) and all clients in settings with a ⬎1% HIV prevalence. Few studies have explored the association between patient predictors of HIV testing and HIV testing among health care providers. The purpose of this study was to determine factors associated with having HIV testing among adolescents receiving STI services as part of pediatric primary care. Methods: Retrospective chart review of adolescents and young adults who were screened for an STI in an urban academic primary care practice in a high STI and HIV prevalence community. Data abstracted from chart include demographics HIV status, STI at the visit, provider experience, diagnosis, number of current partners, history of STI, and HIV STI risk reduction counseling. The major outcome was lab evidence of HIV testing. Patients who were known to be HIV positive at the time of diagnosis were excluded from analyses. Multivariate logistic regression was used to examine all significant independent relationships.
49. EVALUATION OF URBAN FEMALE ADOLESCENT COMPREHENSION OF LEVONORGESTREL (PLAN B) PACKET INFORMATION Mara Minguez, MD, Mary Rojas, PhD, Maybelin Rivera. Dept. Pediatrics, Mt. Sinai Hospital, New York, NY.
Purpose: Assess urban female adolescent comprehension of Plan B packet information. Hypothesis: Most female teenagers in an urban clinic, from 12-17 years old, are capable of understanding proper use of Plan B by reading the information provided in the packet. Introduction: The CDC has reported that teen pregnancy rate has declined over the last 10years. Levonorgestrel (Plan B) has become an important part of teen pregnancy prevention. Proper use within 72 hours can decrease pregnancy by 85%. The Food and Drug Administration has repeatedly declined Barr Laboratory’s (manufacturers of Plan B) application for over-the-counter formulation because of lack of information regarding its use in the young adolescents. Methods: An anonymous survey modified from Raymond et al’s study, was administered to 101 adolescent females from 12-17 yrs old in an urban clinic. A Plan B packet was distributed along with the survey and the subjects were asked to answer questions addressing basic information, indication, contraindication and side effects of Plan B. Demographic information such as age, race, sexual activity, prior use of birth control and or Plan B, pregnancies, and prior exposure to information about Plan B was assessed. A comprehension tool adapted from the NYC public school reading tests was administered to all subjects and half further completed the Rapid Estimate of Adult
Abstracts / 38 (2006) 137–163
Results: Participants were young (mean age⫽19.2 years), single (92.0%), diverse (44.1% non-Caucasian), and sexually experienced (85.4%). The prevalence rate of CT at T1 was 14.0%. At follow-up, the infection rates were 25 (3.9%), 64 (9.9%), and 65 (10.0%) at T2, during the interim period, and T3, respectively. Accounting for overlap in diagnoses of the same individuals between the T3 interim period and the T3 biological tests, the overall acquisition rate for CT during the one-year follow-up period was 20.0%. Conclusions: CT is prevalent among women entering recruit training for the Marine Corps, suggesting the need for universal screening for CT among women entering military service. CT acquisition rates at T2 (3.9%), T3 (10.0%) and by self-report (9.9%) were also high, demonstrating the importance of more frequent CT screening of all sexually active women and provision of intensive preventive health care services for all women in the armed forces. Support: Department of Defense, U.S. Army Medical Research and Material Command, Fort Detrick, MD, and the Maternal and Child Health Leadership Education in Adolescent Health.
Results: Of the 150 adolescents, 81% were female, 93% were African American, and 76% had insurance. Mean age of males and females was 17 years old. Fifty-four percent of patients were tested for HIV. Each variable of interest was associated with HIV testing on univariate analysis and contributed to the logistic regression model at p ⬍0.05. Predictor Variable STI at the visit Hx. of STI Provider (resident, fellow, nurse) # of Current partners (0, 1, ⬎1) Risk Reduction Counseling
OR
AOR (95%CI)
2.8 (1.4-5.6) 2.2 (1.1-4.4) 1.8 (1.1-3.2) 3.9 (1.4-10.7) 2.6 (1.2-5.7)
2.7 (1.2-6.7) 1.6 (0.7-3.9) 2.5 (1.2-5.3) 3.6 (1.3-10.0) 1.6 (0.6-4.3)
Conclusion: More than half of patients screened for STIs in this academic primary care practice were also screened for HIV. Testing appears to be associated with risk-assessments by providers, diagnosis at the visit, and provider type. Due to the high prevalence of HIV infection in this community and the potential for missed cases due to risk-category misclassification, further quality improvement efforts that increase patient acceptance of HIV testing and provider adherence to the recommendation for universal counseling and testing are indicated.
48. HIV TESTING IN ADOLESCENTS RECEIVING STI SERVICES IN AN URBAN PRIMARY CARE SETTING Renata Arrington-Sanders, MD, MPH, Jonathan Ellen, MD, Maria Trent, MD, MPH. Division of General Pediatrics & Adolescent Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
Purpose: Up to 30 000 to 100 000 adolescents younger than 25 years old are infected with HIV and 25% are unaware of their status. The Centers for Disease Control and Prevention recommends that universal HIV counseling, testing and referral (CTR) be provided by primary care physicians to all clients in settings serving client populations with lifestyle behaviors that predispose them to increased risk (regardless of setting HIV prevalence) and all clients in settings with a ⬎1% HIV prevalence. Few studies have explored the association between patient predictors of HIV testing and HIV testing among health care providers. The purpose of this study was to determine factors associated with having HIV testing among adolescents receiving STI services as part of pediatric primary care. Methods: Retrospective chart review of adolescents and young adults who were screened for an STI in an urban academic primary care practice in a high STI and HIV prevalence community. Data abstracted from chart include demographics HIV status, STI at the visit, provider experience, diagnosis, number of current partners, history of STI, and HIV STI risk reduction counseling. The major outcome was lab evidence of HIV testing. Patients who were known to be HIV positive at the time of diagnosis were excluded from analyses. Multivariate logistic regression was used to examine all significant independent relationships.
49. EVALUATION OF URBAN FEMALE ADOLESCENT COMPREHENSION OF LEVONORGESTREL (PLAN B) PACKET INFORMATION Mara Minguez, MD, Mary Rojas, PhD, Maybelin Rivera. Dept. Pediatrics, Mt. Sinai Hospital, New York, NY.
Purpose: Assess urban female adolescent comprehension of Plan B packet information. Hypothesis: Most female teenagers in an urban clinic, from 12-17 years old, are capable of understanding proper use of Plan B by reading the information provided in the packet. Introduction: The CDC has reported that teen pregnancy rate has declined over the last 10years. Levonorgestrel (Plan B) has become an important part of teen pregnancy prevention. Proper use within 72 hours can decrease pregnancy by 85%. The Food and Drug Administration has repeatedly declined Barr Laboratory’s (manufacturers of Plan B) application for over-the-counter formulation because of lack of information regarding its use in the young adolescents. Methods: An anonymous survey modified from Raymond et al’s study, was administered to 101 adolescent females from 12-17 yrs old in an urban clinic. A Plan B packet was distributed along with the survey and the subjects were asked to answer questions addressing basic information, indication, contraindication and side effects of Plan B. Demographic information such as age, race, sexual activity, prior use of birth control and or Plan B, pregnancies, and prior exposure to information about Plan B was assessed. A comprehension tool adapted from the NYC public school reading tests was administered to all subjects and half further completed the Rapid Estimate of Adult