In The News: Point-of-Care Saliva Testing Raised HIV Screening Rate at Adolescent Clinic

Healio reports on findings presented at PAS on HIV screening success by a clinic that offered point-of-contact saliva testing. The clinic’s efforts resulted in quadrupling its screening rate. The median screening rate for those aged 16-18 years at the clinic was 12% from 2017-2021 and increased to 55%. The option alleviated concerns by some patients on having blood drawn, and presents an important option as CDC data from 2018 show 35% of adolescents (13-24 years of age) with HIV do not know they have it.

Teenage patients received printed material about screening and were provided options to check prior to appointment. For those who agreed to testing, an oral swab was collected before being asked about their sexual history. If a patient shared high-risk sexual behavior, they were also tested for other STIs. The clinic used an oral swab that detects antibodies to HIV-1 and HIV-2 with a high sensitivity (99.3%) and specificity (99.8%). The results are returned in 20 minutes.

Another aspect of the intervention included educating providers about recommendations for HIV screening. Researchers set out to determine why universal HIV screening rates remain low. The American Academy of Pediatrics updated its HIV screening guidelines in 2021 to recommend all patients 15 years of age and older be screened at least once regardless of sexual history, prevalence rates, or high-risk behaviors. Among the reasons researchers found were a fear of needles or having blood drawn, delay in learning results, and how results were communicated.

Compared to U.S. adults, youth with HIV are less likely to have received care, be retained in treatment, and be virally suppressed. The researchers suggest taking HIV testing into community/neighborhood settings or at-home testing to help improve youth HIV care. Knowing HIV status and knowing it early will help teens get treatment and prevent further HIV spread.

PIDS member Claudia Vicetti commented on the story, “Identifying and overcoming barriers to HIV screening in adolescents and young adults is crucial for achieving HIV elimination in the U.S. Saliva-based HIV testing is particularly appealing to youth who may fear needles and thus decline testing if no alternative methods are offered. While saliva tests offer a good option for standard-risk patients, they only detect antibodies and may miss individuals in the early phase of infection, unlike 4th generation antigen/antibody tests. This limitation makes saliva tests less ideal for sexually active youth in high prevalence areas or for those being assessed for HIV Pre-Exposure Prophylaxis. However, this study initiates an important conversation for pediatric institutions to come up with ways to increase their youth HIV screening rates and adhere to AAP’s universal screening recommendations. Organizations implementing workflows that include point-of-care testing should be encouraged to share their implementation outcomes, enabling other institutions to inform their approaches based on real-world data.”