Development of a model to implement guideline-concordant STI/HIV healthcare and screening for adolescents in the pediatric emergency department

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Project summary Adolescents (13-17 year-olds) in the United States (US) are at high risk of acquiring sexually transmitted infections/diseases (STIs), such as chlamydia, gonorrhea, and trichomonas, as well as HIV. Many adolescents who receive care in US pediatric emergency departments (PEDs) are diagnosed with or at risk for STIs and HIV, rendering PEDs a major venue for STI/HIV healthcare delivery and prevention in the US. However, previous research findings demonstrate that STI/HIV healthcare and screening provision in US PEDs is not concordant with guidelines from the Centers for Disease Control and Prevention (CDC). As a consequence, adolescents with or at-risk for STIs and HIV can develop adverse sequelae of undiagnosed or inadequately treated infections (e.g., infertility), and perpetuate the transmission of these infections. Assuring that adolescents receiving care in US PEDs obtain guideline-concordant healthcare for potential STIs and that at-risk adolescents are screened for STIs and HIV should assist in reducing the high rates of STIs and HIV among this vulnerable population. Providing guideline-concordant healthcare could also preserve their future health, as well as of their sexual and drug-using partners. Unfortunately, research is lacking on how guideline-concordant and recommended healthcare for adolescents at risk for or with suspected STIs/HIV can be implemented in PEDs. In this R21 project, we will address the deficit of research on implementation in US PEDs of guideline- concordant care of adolescents with suspected or who are at risk for STIs and HIV. With the assistance of community, hospital and PED stakeholders, we will identify determinants of providing guideline-concordant STI/HIV healthcare and screening to adolescents in a New York City (NYC) PED. Afterwards, we will select then pilot test implementation strategies to improve STI/HIV healthcare and screening provision. The product of this R21 will be a model of how to implement guideline-concordant STI/HIV care in a PED. In a subsequent R01-supported study, we will evaluate how the model can be implemented in other PEDs in the NYC area. This R21 project will proceed in three iterative aims using Implementation Mapping as a process framework. In Aim 1, we will assess determinants of the provision of guideline-concordant STI/HIV healthcare and screening for adolescents at the Mount Sinai Hospital PED using the Tailored Implementation in Chronic Diseases checklist. In Aim 2, we will select implementation strategies to address the determinants of the provision of guideline-concordant STI/HIV healthcare and screening for adolescents commensurate with the Mount Sinai Hospital PED’s capabilities and resources and the needs of its adolescent patients. In Aim 3, we will conduct a pilot study that evaluates the feasibility and acceptability of the implementation strategies selected in Aim 2 and will estimate their potential in increasing guideline-concordant STI/HIV healthcare and screening for adolescents.