210 - Leveraging Emergency Care to Advance HIV Prevention in Youth: Outcomes of a PrEP Navigation Protocol

Publication Number: 2202.210

Katherine E.. Redden, Nationwide Children's Hospital, Columbus, OH, United States; Megan Brundrett, Nationwide Children's Hospital, Powell, OH, United States

Background: Annual human immunodeficiency virus (HIV) screening in sexually active adolescents and young adults (AYA) is recommended, with increased frequency for those at high risk, such as those diagnosed with other sexually transmitted infections (STIs). Individuals aged 13 to 24 years old make up 20% of new HIV diagnoses, and this group has disproportionately high rates of STIs. Preexposure prophylaxis (PrEP) is a key HIV prevention tool, but despite its efficacy, uptake in AYA is suboptimal, hindered by barriers. Within our pediatric emergency department (ED), only 37% of patients were tested for HIV when gonorrhea/chlamydia testing was obtained.

Objective: As part of a larger quality improvement (QI) initiative to increase HIV testing in a pediatric ED, AYA with a positive gonorrhea (GC) and/or syphilis test were referred to PrEP navigation to increase linkage to STI treatment, HIV testing, and PrEP within primary care.

Design/Methods: A multidisciplinary team conducted a review of data and processes. Interventions were executed using the Plan-Do-Study-Act methodology. A follow-up protocol was developed for positive GC or syphilis results from ED visits. The PrEP Navigator communicated results and completed phone assessments to educate and determine PrEP eligibility and interest. When empiric treatment was not given, the PrEP Navigator facilitated linkage to primary care for treatment and HIV testing.

Results: HIV screening among AYA being tested for GC/CT in the ED increased from 37% to 69% with all QI interventions, including implementation of a follow-up protocol for positive GC or syphilis results. Between May 2024 and September 2025, 69 patients tested positive for GC; no syphilis cases were identified. Of these, 61%(n=42) received empiric treatment. 84%(n=58) were contacted, with the remaining 16%(n=11) excluded due to sexual assault or inpatient admission. Among those reached, 52%(n=30) completed a phone assessment and 27%(n=8) expressed interest and attended an HIV prevention visit, with one initiating PrEP. 45%(n=31) of patients with positive GC results got HIV testing during their ED visit. Of those contacted for follow-up, 17%(n=10) were tested for HIV after their ED visit.

Conclusion(s): The implementation of a multi-pronged QI initiative successfully increased HIV screening in AYA who were tested for STIs during their ED visit. The follow-up protocol intervention modestly improved HIV screening, but was ineffective among patients who got empiric treatment in the ED. While the PrEP Navigator facilitated meaningful engagement, PrEP initiation was minimal, highlighting the persistent barriers to uptake.