Perseverance Pays Off: Health Care Providers' Impact on HIV Testing Decisions by Adolescent Females

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Abstract
Background and objective. Although HIV counseling and testing of adolescents has increased rapidly in recent years due to increasing HIV seroprevalence rates, little is known about adolescents' use of HIV testing services. The aims of this study were to determine what proportion of high risk adolescent girls would use confidential HIV testing services linked to primary care and to explore the characteristics, beliefs, and experiences that distinguish those teenage girls who obtain HIV testing in this setting from those who do not. Design. Prospective cohort study. Setting. General pediatrics clinic with adolescent-specific appointments at a large urban HMO. Participants. Convenience sample of 124 adolescent girls engaging in risky behaviors identified by chart review before regularly scheduled clinic appointments. Intervention. Subjects completed a self-report questionnaire assessing HIV-related knowledge, attitudes, beliefs, and behaviors before the medical visit. During their provider visit, teens were counseled about their risk behaviors and the availability of HIV testing services at the clinic. Subjects were also given the opportunity to view an educational video about HIV testing designed for adolescents. Main outcome measures. Use of HIV counseling and testing services at the clinic and HIV test results. Results. Forty-one percent of these adolescent girls obtained HIV testing at the clinic on the day of their scheduled appointment. Univariate analysis revealed that adolescents who obtained testing had initiated sexual intercourse at a younger age (mean age 13.8 vs 14.4 years, P = .02) and were more likely to have had a prior discussion about HIV testing with a health care provider [RR = 2.02, 95% CIs (1.22, 3.36)]. Those who did not view the video were less likely to test [RR = 0.20, 95% CIs (0.07, 0.58)]. Multiple logistic regression modeling revealed that a prior discussion with a health care provider was the only independent predictor of obtaining an HIV test [OR = 3.47 95% CIs (1.26, 9.52)]. Conclusions. A significant proportion of adolescent girls engaging in risky behaviors will use confidential HIV counseling and testing services that are linked to primary care. Health care providers play an important role in helping teens address their risk for and concerns about HIV infection by engaging adolescents in repeated discussions about HIV testing.
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