P2B062: Providing Screening and Linkage to Preventive Services for At-risk Hiv-negative Patients Aged 13 to 18 in a Pediatric ED

Purpose/Objectives: The Pediatric Emergency Department (ED) at LAC+USC Medical Center serves many teenage patients with circumstances and behaviors that place them at risk for HIV. Since May 2022, our department has been conducting opt-out, non-targeted screening for HIV among patients ages 13-21 receiving blood draws, and for those who are HIV-negative, providing risk-assessments to determine need for education and eligibility for linkage to comprehensive outpatient prevention services (CPS).

Design/Methods: Selection criteria for program participation include medically stable ED patients, 13-21 years old, not in the custody of law enforcement, negative for HIV on routine screening. Patients meeting eligibility criteria were screened for behavioral risk factors, and if identified as at-risk, offered linkage to outpatient prevention services. In this paper we describe demographics and key program outcomes for minor patients including number of patients screened, provided with risk assessment, offered linkage to CPS, and attended CPS, as well as general categories of CPS attended May 1, 2022 to February 28, 2023. This study was approved by the University of Southern California IRB

Results: Of patients ages 13-17 presenting to the ED during the study period, 110 of 121 were eligible for risk factor screening. Reasons for ineligibility included in custody of law enforcement (and therefore unable to arrange outpatient services) and not stable from a medical or psychiatric standpoint for evaluation. Among those eligible for risk factor assessment 37 identified as male, and 72 identified as female, 86 (78%) were Hispanic, 6 (5.5%) were Black, 86 (78%) Medicaid insurance, 41 (37%) spoke Spanish and 65 (59%) spoke English language. Among the 52 (%) with risk factors, the distribution was 44 (%) for high-risk sexual behavior and 24 (%) for other behavior-modifying drug use. Among the eligible for assessment, linkage to CPS was offered to 35 (32%), and scheduled and attended for 26 (24%). Notably, of those offered, 27 (77%) were female and of those scheduled and attended, 24 (92%) were female. Reasons not scheduled were commonly cited as desire to follow-up with own physician, or declined due to lack of interest or perceived need by patient.

Conclusion/Discussion: We have identified a notable gender disparity with females than male patients being screened and linked to care. We suspect that this is related to relatively large volume of female patients in the Pediatric ED presenting with OB/GYN complaints. Given this noted gender differential, it will be important for our OB/GYN colleagues to continue to conversation and offer patients a full range of options for CPS. Additionally, ways in which young men can be targeted for screening and linkage need to be explored and identified to bridge the gender gap.