1. HIV Testing in the Pediatric ED:
Workflow and Linkage to Care

2. Peds ED HIV Testing Workflow:
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)
HIV staff provide test result to patient
(and link to care with provider assistance as necessary)
HIV staff communicates w/ peds provider
(to coordinate best time to perform test)

3. Step 1: Peds HIV Screening Question/Consent
HIV staff unavailable to perform POC oral test at this time; HIV blood test can be ordered at provider’s discretion.
“STOP”

4. STEP 2: Peds POC Oral HIV Test Order
STEP 1: Peds HIV Screening Question
Chart Documentation:
STEP 2: Peds POC Oral HIV Test Order
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.

5. 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.

6. 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

7. Step 4: HIV Staff Perform Test
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)
*POC OraQuick test should not be used for the acutely ill patient*
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

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

9. 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.

10. Step 5: HIV Staff Provide Results
For a CONFIRMED POSITIVE HIV test:
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)
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 voic notifying Anastasia that a patient needs follow up, and send her an with patient’s CURRENT contact info:
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.

11. ED Research Coordinators/HIV Program Staff:
From L-R: Somiya Haider; Mitra Lewis; Dani Signer; Maggie Leathers; Boris Tizenberg

12. PEDS HIV Program Contacts:
HIV Program Staff:
Ascom:
Office: (443)
Pager: (410)
Danielle Signer
Research Program Coordinator
Ext:
Cell: (202)
Stephen Peterson
Research Program Manager
Work:
Cell:
Jamie Rogers, RN
HIV Nurse Manager, Harriet Lane Clinic
Work: (410)
Cell: (410)
Anastasia Wynn
SMILE Linkage to Care Coordinator
Cell: (410)
Richard Rothman, MD
Adult EM
Work: (410)
Mobile: (443)
Mitchell Goldstein, MD
Pediatric EM
Work: (443)
Renata Sanders, MD
Adolescent Medicine
Work:
Errol Fields, MD
Work