Research In Practice Blog

Clinician speaks with adolescent in clinical setting
Advancing Adolescent HIV Prevention Through Point-of-Care STI Testing
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By Susan Lee, MPH, Alexander G. Fiks, MD, MSCE, Nadia L. Dowshen, MD, MSHP, AAHIVS and Lindsey Klinger-O'Donnell

Introduction

According to the Centers for Disease Control and Prevention (CDC), sexually transmitted infections (STIs) are common among teenagers and young adults, accounting for nearly half of all STI cases. Having an STI can increase a person's risk of getting human immunodeficiency virus (HIV). Even though STI testing and HIV prevention often go hand in hand, these services are not always offered together for young people in the United States.  

The CDC recommends that sexually active adolescents be routinely screened for gonorrhea (GC) and chlamydia (CT), two of the most common STIs, and that young people who get tested for an STI should also be tested for HIV. Additionally, they recommend that all sexually active youth learn about HIV pre-exposure prophylaxis (PrEP), a medication that can significantly reduce the risk of getting HIV, and that youth diagnosed with an STI be offered PrEP if appropriate.

However, these recommendations are not always put into practice. Only about half of young people diagnosed with an STI receive an HIV test, and relatively few adolescents and young adults use PrEP. As a result, many adolescents may not be getting the HIV prevention services that could help support their health.

To better protect young people from HIV, healthcare providers are seeking new ways to make HIV testing and prevention services easier and more accessible. One promising approach is point-of-care testing for GC/CT. Unlike traditional lab tests, which can take two to three days for results, rapid point-of-care tests are done right in the clinic and provide results in about 30 minutes or less. This allows healthcare providers to discuss results, offer treatment, and connect patients with HIV prevention services during the same visit. Although the first Food and Drug Administration (FDA)-approved point-of-care test for GC/CT became available in 2021, little is known about how well this approach works in pediatric and adolescent healthcare settings.

Exploring the Study Intervention  

A new project, led by researchers from Clinical Futures and PolicyLab at Children’s Hospital of Philadelphia, will test whether offering a GC/CT rapid point-of-care test (POCT) can improve HIV testing, PrEP counseling, and PrEP delivery rates and whether it is a feasible, acceptable, and appropriate implementation strategy for adolescents seeking STI testing in pediatric settings. Clinical Futures and PolicyLab experts Drs. Nadia Dowshen, MD, MSHP, and Alex Fiks, MD, MSCE, along with study lead Dr. Sarah Wood, MD, MSHP, Division Chief of Adolescent Medicine and Director of the Mount Sinai Adolescent Health Center, and study team members, including Dr. Sarah Crook, PhD, MS, Naomi Pressman, MS, RD, Susan Lee, MPH, and Eliza Keefe, will spearhead this work.  

This study has two main aims:  

  1. Aim 1: Collect and evaluate electronic health record (EHR) data from approximately 12,000 adolescents ages 16-24 years who have received point-of-care (POC) or lab-based GC/CT testing across three CHOP adolescent health clinics, excluding patients living with HIV or taking PrEP. Using a phased implementation design, researchers will assess associations between STI testing modality and delivery of integrated STI and HIV prevention services in adolescents.  
  2. Aim 2: Recruit adolescents, meeting Aim 1 inclusion criteria noted above, and healthcare providers involved in POC or lab-based GC/CT testing procedures across the same three CHOP adolescent health clinics.  

To understand how well rapid, in-clinic testing for GC/CT works in pediatric healthcare settings, researchers will gather information in several ways. They will survey patients and healthcare providers, conduct interviews, and analyze electronic health record data. By combining these insights, the team will assess whether this testing approach is practical to use, well accepted by patients and providers, and an effective way to connect young people with HIV testing and prevention services.  

Research in Practice Implications

The findings from this study will help lay the groundwork for future large-scale trials testing the clinical effectiveness of rapid GC/CT POCT as a strategy to improve HIV testing and PrEP delivery outcomes in pediatric healthcare more broadly. Ultimately, this approach can aid pediatric healthcare providers in delivering more effective and convenient HIV prevention services to adolescents.  

Project Title: Clinical and Implementation Outcomes of a Point of Care (POC) Sexually Transmitted Infection (STI) Testing Strategy to Improve HIV Prevention Service Delivery in Adolescents  

Funders: Icahn School of Medicine at Mount Sinai; National Institute of Mental Health (NIMH)  

References: 

  1. Centers for Disease Control and Prevention. Sexually Transmitted Infections Surveillance, 2023. National Center for HIV, Viral Hepatitis, STD, and TB Prevention (U.S.); Division of STD Prevention. Accessed May 19, 2026. https://www.cdc.gov/sti-statistics/media/pdfs/2025/09/2023_STI_Surveill…  
  2. Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. Jul 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1  
  3. Centers for Disease Control and Prevention: U.S. Public Health Service. Preexposure prophylaxis for the prevention of HIV infection in the United States–2021 Update: a clinical practice guideline. National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (U.S.); Division of HIV/AIDS Prevention; Preexposure Prophylaxis Work Group. Accessed May 19, 2026. https://stacks.cdc.gov/view/cdc/112360/cdc_112360_DS1.pdf  
  4. Petsis D, Min J, Huang YV, Akers AY, Wood S. HIV Testing Among Adolescents With Acute Sexually Transmitted Infections. Pediatrics. Apr 2020;145(4):e20192265. doi:10.1542/peds.2019-2265  
  5. Watson DL, Shaw PA, Petsis DT, Pickel J, Bauermeister JA, Frank I, Wood SM, Gross R. A retrospective study of HIV pre-exposure prophylaxis counselling among non-Hispanic Black youth diagnosed with bacterial sexually transmitted infections in the United States, 2014–2019. J Int AIDS Soc. Feb 2022;25(2). doi: 10.1002/jia2.25867  
  6. Yusuf H, Fields E, Arrington-Sanders R, Griffith D, Agwu AL. HIV Preexposure Prophylaxis Among Adolescents in the US: A Review. JAMA Pediatr. Nov 2020;174(11):1102-1108. doi: 10.1001/jamapediatrics.2020.0824