184 - Promoting Consistent and Accurate Sexually Transmitted Infections and HIV Screening of Adolescents in Two Primary Care Clinics

Poster Number: 184
Publication Number: 184.142

Tomitra Latimer, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Kate Balsley, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Brooke K. Pfister, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States; Sameer J. Patel, Ann & Robert H. Lurie Children's Hospital of Chicago, CHICAGO, IL, United States

Background: Adolescents account for half of all new STI infections. The American Academy of Pediatrics (AAP) recommends universal HIV screening in 16-18 year-olds regardless of sexual activity and the AAP recommends appropriate sexually transmitted infections (STI) screening for sexually active adolescents. Residents and Faculty at two primary care clinics inconsistently follow these STI/HIV screening guidelines.

Objective: Our aim was to increase universal HIV screening in all 16-18-year-olds by 90% and increase appropriate STI/HIV for sexually active adolescents by 90%.

Design/Methods: After a current state analysis review, we noted several areas for improvement. We implemented several interventions to increase knowledge of the STI/HIV screening guidelines. First, we created a sexual health history query in the 13-18-year-old well child check (WCC) notes templates and collected data based on clinicians' responses. Second, we provided educationally sessions for Residents and Faculty; hosted a journal club that reviewed universal HIV screening and provided targeted clinical education to several Resident continuity clinics. Third, to reach more clinicians, we added electronic medical records (EMR) alerts to the 13-18-year-old WCC order sets to prompt screening for STI/HIV screening labs, if appropriate. STI screening labs include Gonorrhea and Chlamydia (GC/CT), syphilis and HIV. Finally, we offered Faculty Maintenance of Certification Part 4 credit to incentivize participation of Faculty who supervise residents during continuity clinics (CC). The seven Faculty that attended helped refine and added to the interventions.

Results: From January 2018 to November 2021, clinic #1 had 1868 adolescent visits. Universal HIV screening increased from 22% to 30%. In clinic #2, the increase was more substantial rising from 3% to 30% with 1065 adolescent visits from August 2019 to November 2021. During the same period, increases in STI screening rates in clinic #1 and clinic #2 were not noted.Conclusion(s): To our knowledge, this is the first Quality Improvement project that focused on not just universal HIV screening, but a complete STI screening when adolescents share they are sexually active. We experienced several challenges during this project chiefly due to the differences between clinic #1 and #2. Only 50% of supervising faculty in clinic #2 had academic faculty appointments, making dissemination of guidelines difficult compared to Faculty in CC in clinic #1. Also, clinic #1, staff can obtain blood during the clinic visit, but in clinic #2 adolescents must go to a separate building for lab draws which served as a barrier.
Multiple PDSA cycles promoting screening of HIV and Sexually Transmitted Infections (STIs)Interventions to increase knowledge ranged from targeted education, MOC Part 4 credit to incentivize Faculty to utilizing Electronic Medical Records (EMR) to prompt Residents and Faculty
% of 16-18 -years-olds with resulted universal HIV screening in clinic #1% of Received and Resulted HIV Test for patients 16-18-years-of age from January 2018 to September 2021 (when data collection began at clinic #1)