Implementing Routine HIV Screening in an Urban Adolescent Population at a General Pediatric Clinic.

PURPOSE: To increase the rate of routine HIV screening during preventative visits for adolescent patients aged 15 to 21 in a pediatric and adolescent clinic in accordance with national recommendations, which are poorly implemented nationwide. METHODS: This was a quality improvement initiative. Four plan-do-study-act (PDSA) cycles were conducted from May 2016 to February 2020. Interventions included education of and reminders for the multidisciplinary team on guidelines and testing, creation of a standardized workflow, introduction of a rapid point-of-care HIV antibody test (POCT), and implementation of an opt-out, medical assistant/nursing-driven protocol for HIV rapid point-of-care testing. The primary outcome measure was the monthly percentage of adolescents screened for HIV during preventative visits. Data is presented in a p-control chart and means were adjusted for special cause variation according to the Institute for Healthcare Improvement guidelines. RESULTS: Rates of routine HIV screening at preventative visits for youth ages 15 to 21 increased from the pre-intervention rate of 5.16% to a final rate of 41.5% over four PDSA cycles. Mean screening rates were adjusted after introducing the HIV POCT (+18.5%) and after implementing the medical assistant/nursing-driven protocol (+17.9%). CONCLUSIONS: We successfully increased routine HIV screening rates at preventative visits for adolescents at an urban pediatric and adolescent clinic. This was in large part due to testing with a rapid HIV POCT and a clinic protocol allowing medical assistants and nurses to order the test under a physician's name as part of the intake process. Ours can be a model for other clinics.

Neurodevelopmental Exam Recommendations for Children With HIV Infection.

Multiple and complex health, social, and environmental factors threaten the school success of children living with HIV. Little is known about interventions to overcome these threats to school success. We aimed to identify the number and types of recommendations from hospital-generated neurodevelopmental exams and school-generated evaluations, Individual Education Plans (IEP), and 504 Plans for adaptations in the classroom for students with HIV infection. We also compared recommendations suggested by both neurodevelopmental exams and IEPs or 504 Plans. Data were derived from the clinic records of 31 school-age children. Content analysis yielded 358 recommendations in 11 categories. Findings highlighted a lack of communication between the clinic and schools.

Hypersensitivity to efavirenz treated with corticosteroids in a 6-year-old child.

We report a case of the successful use of corticosteroids to treat hypersensitivity caused by efavirenz in a pediatric patient. A 6-year-old HIV-infected patient developed a diffuse erythematous rash and fever after being switched to a regimen containing efavirenz. Use of prednisone at a dose of 1 mg/kg every other day for 2 weeks on rechallenge resulted in successful reinstitution of the regimen.