Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic

In 2006, the US Centers for Disease Control and Prevention issued recommendations supporting routine HIV testing in health care settings for all persons aged 13 to 64 years. Despite these recommendations, physicians are not offering HIV testing routinely. We apply a model that has previously identified 3 central, inter-related factors (knowledge-, attitude-, and behavior-related barriers) for why physicians do not follow practice guidelines in order to better understand why physicians are not offering HIV testing routinely. This model frames our review of the existing literature on physician barriers to routine HIV testing. Within the model, knowledge barriers include lack of familiarity or awareness of clinical recommendations, attitude barriers include lack of agreement with guidelines, while behavioral barriers include external barriers related to the guidelines themselves, to patients, or to environmental factors. Our review reveals that many physicians face these barriers with regards to implementing routine HIV testing. Several factors underscore the importance of determining how to best address physician barriers to HIV testing, including: provisions of the Affordable Care Act that are likely to require or incentivize major payers to cover HIV testing, evidence which suggests that a physician’s recommendation to test for HIV is a strong predictor of patient testing behavior, and data which reveals that nearly 20% of HIV-positive individuals may be unaware of their status. In April 2013, the US Preventive Services Task Force released a recommendation supporting routine HIV testing; strategies are needed to help address ongoing physician barriers to testing.

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“…29 A 2010 study of VA primary care providers found that nearly 40% of providers were unaware of the 2006 CDC recommendations. 30 …”

Section: Methodsmentioning

confidence: 99%

Physician Barriers to Successful Implementation of US Preventive Services Task Force Routine HIV Testing Recommendations

Zheng

Suneja

Chou

et al. 2014

J Int Assoc Provid AIDS Care

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“…The cause of inconsistency merits further research since statutes do not pose a substantial barrier in either jurisdiction. [14] Previous implementation research has shown that this inconsistency may be due to 1) a lack of awareness or misunderstanding of the recommendations, [27] , [32] , [33] 2) disagreement with the recommendations, [34] and/or 3) organizational barriers that impede application of the recommendations. [27] , [28] , [30] , [35] , [36] Both cities may benefit from further research into why organizations continue to use both pre- and post-test counseling and do not use opt-out testing.…”

Section: Discussionmentioning

confidence: 99%

HIV Testing Implementation in Two Urban Cities: Practice, Policy, and Perceived Barriers

et al. 2014

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BackgroundAlthough funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown.MethodsWe conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions.ResultsIn 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC.ConclusionsGiven unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.

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“Oops! I forgot HIV”: Resident physician self-audits and universal HIV screening

Brennan

Barocas

Crnich

et al. 2015

Journal of Infection and Public Health

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Are VA Primary Care Providers Aware of HIV Testing Recommendations for Veterans? Findings at an Urban VA Primary Care Clinic

Cited by 3 publications

References 16 publications

Physician Barriers to Successful Implementation of US Preventive Services Task Force Routine HIV Testing Recommendations

Physician Barriers to Successful Implementation of US Preventive Services Task Force Routine HIV Testing Recommendations

HIV Testing Implementation in Two Urban Cities: Practice, Policy, and Perceived Barriers

“Oops! I forgot HIV”: Resident physician self-audits and universal HIV screening

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