Project Description Narrative:
Human immunodeficiency virus (HIV) continues to be a serious health issue worldwide. In Milwaukee, more young people are getting diagnosed with HIV compared to other parts of the U.S. This means that new methods are needed to help prevent HIV among young people in the community. One of the tools to prevent HIV is testing. HIV testing is important because it can help diagnose people with HIV infection early and offer proper treatment that can prevent the harmful outcomes of advanced HIV disease. Also, it allows providers to give advice to those who test negative on ways that they can remain HIV-free.
Young people are more likely to have other infections transmitted through sex such as gonorrhea, chlamydia, or syphilis, and studies have shown that people with these infections have a higher chance of getting HIV in the future. The Centers for Disease Control and Prevention (CDC) recommends that patients who are being tested for these other infections are also tested for HIV. They also recommend that those who were previously diagnosed with gonorrhea or chlamydia should also be tested for syphilis and HIV. This is especially important in Milwaukee County because the syphilis rates have increased dramatically since 2015.
Many teens and young adults still go to their pediatrician for routine check-ups, sports physicals, and vaccines. We know that teens and young adults who go to see their pediatrician in Milwaukee County are routinely tested for gonorrhea and chlamydia, and even though one in four will have a positive test for either gonorrhea, chlamydia, or both fewer than one in five of them also get tested for syphilis and HIV. So, 80% of adolescents and young adults who should be screened for HIV and syphilis are not getting appropriately tested.
One approach to increase the number of people being tested for HIV and syphilis is by making it part of the normal check-up process and by offering a test that can be done quickly by a staff member in the pediatric clinic, with results being available before the patient leaves the office. Rapid tests have been studied and approved by the Food and Drug Administration to diagnose HIV and syphilis, but they are not currently available at pediatrician's offices. When these rapid tests have been studied in clinics that see adults seeking testing for sexually transmitted infections (STIs) or in emergency rooms, the quick results have led to a faster diagnosis and timely referral for treatment and consideration of medications to prevent HIV, which is called PrEP (Pre-Exposure Prophylaxis).
While there are other things that pediatricians need to address during routine check-ups that do not pertain to STIs and there is usually limited allotted time to take care of each patient, the researchers believe rapid tests can help get more people tested if it is incorporated into the workflow of primary care pediatric clinics.
Through this research, they seek to 1) Learn what makes it easy or hard for pediatric clinics to offer the rapid tests for HIV and syphilis and what makes it easy or hard for a patient to agree to have this test done; 2) Start testing for HIV and syphilis with rapid tests at pediatrician's offices in Milwaukee and measure how many people get tested; and 3) Look at how well the testing process works using a special framework that can measure how successful the entire process is. To do this, they will interview doctors, staff, and patients to understand what they think about testing for HIV and syphilis using these rapid tests. Then, they will make these tests available and use what we learned in interviews to change clinic systems to increase testing utilization. They will teach doctors, nurses, and medical assistants how these tests work and who are the appropriate patients to offer tests, modify the clinic's computer system to enhance clinic workflow, and measure how the number of patients tested changes over time. These numbers will include how many people got tested, how many were found to have HIV or syphilis, and how well they get referred for treatment. The researchers will also look at the costs associated with this process, and they will ask providers what they think after the study. If this process is successful and they can show that rapid HIV and syphilis tests are simple to perform, increase the number of patients tested and the benefits are worth the costs, the project team plans to provide important information for other pediatric clinics to do the same across the state and the nation.
By increasing testing, more young people can receive timely HIV treatment or PrEP which in turn could lead to fewer HIV infections in young people in the future.