HIV Testing in the

Pediatric ED:Workflow and Linkage to Care

HIV staff provide test result to patient (and link to care with provider assistance as necessary)

HIV Test Offer/Consent performed by triage ‘expeditor’ (or first assigned provider)

HIV Test “Order” (placed by expeditor/provider)

HIV Program receives Page (includes patient info)

HIV staff provide pre-test counseling, re-consent patient, and perform oral test

HIV staff requisition/result HIV test in PDS (HIP) (interfaces w/ EPIC)

Peds ED HIV Testing Workflow:

HIV staff communicates w/ peds provider (to coordinate best time to perform test)

“STOP”

Step 1: Peds HIV Screening Question/Consent

CONSENT

HIV staff unavailable to perform POC oral test at this time; HIV blood test can be

ordered at provider’s discretion.

STEP 2: Peds POC Oral HIV Test Order

STEP 1: Peds HIV Screening Question

Chart Documentation:

This is a POC oral HIV screening test that will be performed by Adult ED HIV program staff; it is not a test that Johns Hopkins Laboratory administers or results.

Step 3: HIV Staff is Paged

Once physician “orders” HIV test in HMED, HIV pager receives a page.

HIV staff will communicate with pediatric pt’s provider within 20 minutes of the time the order is placed (POC test will often be ordered by triage expeditor)

It is critical that the POC HIV oral test order (step 2) is completed in HMED correctly this is how HIV staff receive notice of pending peds tests.

Step 4: HIV Staff Perform Test• HIV testing facilitator will come to the patient’s room to

provide pre-test counseling and perform oral swab

• Facilitator will first re-consent the patient (after asking any family present to leave the room)

• After obtaining consent, facilitator will provide pre-test counseling, which will cover topics such as:• Risk factors• Safe sex practices• What will happen if they are positive?

• Who could patient tell?• Inform patient briefly about available

treatment/care.

• Encourage patients to discuss test/results with parents

• Facilitator performs oral swab in patients room, and starts running test (will either run test in peds ED or take back over to adult side)

• Facilitator requisitions POC oral HIV test in PDS/HIP (which is interfaced with SOFT/EPIC)

Step 4: HIV Staff Perform Test

• After test runs for 20 minutes, facilitator enters test results into PDS/HIP, communicates results to provider, and delivers test results to patient (in room, without parents present)

• Facilitator requisitions and results HIV test in PDS (HIP), which is interfaced with SOFT/EPIC

*POC OraQuick test should not be used for the acutely ill patient*

Step 5: HIV Staff Provide ResultsFor NEGATIVE screening test results:• After entering results into PDS, HIV staff will inform the patient of negative result and provide

post-test counseling;• Result will be provided within ~30 minutes of test start time• Post-test counseling will include: routine HIV testing recommendations, free testing

sites, and any other questions/concerns the patient may have.• Provide ‘negative brochure’ and encourage patient to discuss HIV testing withparents/family.

*Facilitator will communicate results to clinical team and disclose to patient with provider assistance*

Step 5: HIV Staff Provide Results*Facilitator will communicate results to clinical team and disclose to patient with provider assistance*

For a REACTIVE screening (POC) test:• HIV staff will first communicate results of reactive POC test to patient’s provider;• HIV facilitator and treating physician will:

Inform patient of reactive screening (preliminary positive) test result and provide initial counseling/support; Clarify that oral swab is a screening test, and must be confirmed by a blood test Obtain Consent Provider will order an HIV Confirmatory Test through HMED (see below)

HIV facilitator will fill out Pathology 9 form (see below) Once specimen has been collected (pink top), HIV facilitator will place BOTH Path 9 form and specimen

inside the SAME biohazard bag, and tube to CORE lab.

• HIV facilitator and treating physician will:• Inform patient of positive confirmatory test result;• Provide counseling highlight importance of treatment and discuss linkage to care (LTC)

• HIV facilitator will:• Complete all required Baltimore City Health Department (BCHD) paperwork – positive

encounter, partner notification, and linkage to care (LTC) forms.• Coordinate linkage to care (LTC)

SMILE LTC Program:HIV staff will contact Anastasia Wynn (SMILE LTC Coordinator)SMILE LTC Cell Phone: (410) 350-9123 • Mon-Fri, 8a–5p: Anastasia will come to Pediatric ED to meet with patient (within one hour);• Evenings/Weekends/Holidays: HIV staff will leave a voicemail notifying Anastasia that a patient

needs follow up, and send her an e-mail with patient’s CURRENT contact info: ajwynn@jhu.edu o HIV staff will confirm up-to-date contact info with every pediatric patient we test

• Anastasia will then contact any patient who tested positive in the pediatric ED during ‘off hours’, and schedule a follow-up appt. to be completed within one business day;

• HIV staff will confirm with Anastasia that first appointment with HIV subspecialty care has been scheduled, and report to BCHD accordingly.

For a CONFIRMED POSITIVE HIV test:

Step 5: HIV Staff Provide Results

ED Research Coordinators/HIV Program Staff:

From L-R: Somiya Haider; Mitra Lewis; Dani Signer; Maggie Leathers; Boris Tizenberg

PEDS HIV Program Contacts:

Richard Rothman, MD Adult EM

Work: (410) 735-6428Mobile: (443) 739-4601rrothma1@jhmi.edu

Mitchell Goldstein, MD Pediatric EM

Work: (443) 287-7209mgoldst2@jhmi.edu

Renata Sanders, MD Adolescent Medicine

Work: 443-287-3976rarring3@jhmi.edu

Errol Fields, MD Adolescent Medicine

Work 410-502-6197Errol.fields@jhmi.edu

Danielle SignerResearch Program Coordinator

Ext: 2-6070Cell: (202) 365-8182dsigner1@jhmi.edu

Stephen PetersonResearch Program Manager

Work: 410-735-6402Cell: 904-962-2001speter28@jhmi.edu

Jamie Rogers, RNHIV Nurse Manager, Harriet Lane Clinic

Work: (410) 502-2316Cell: (410) 733-4805jarogers@jhmi.edu

Anastasia WynnSMILE Linkage to Care Coordinator

Cell: (410) 350-9123ajwynn@jhu.edu

HIV Program Staff: Ascom: 2-6070

Office: (443) 287-6985Pager: (410) 283-6978