Barriers and Facilitators to Routine HIV Testing: Perceptions from Massachusetts Community Health Center Personnel

Johnson, Carey V.; Mimiaga, Matthew J.; Reisner, Sari L.; VanDerwarker, Rodney; Mayer, Kenneth H.

doi:10.1089/apc.2011.0180

Cited by 29 publications

(34 citation statements)

References 15 publications

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“…Among medical directors and administrators from non-Ryan White-supported community health centers in Massachusetts, only 27% were aware of the CDC recommendations compared with 60% in Ryan White-supported centers. 36 Most health care professionals surveyed also believed that they needed to obtain written consent and provide counseling before obtaining an HIV test. Physicians also expressed concerns that patients would not have time to reflect on the significance of an HIV test and make an informed decision about whether to accept the testing.…”

Section: Physician Awareness and Perceptionmentioning

confidence: 99%

“…37 Health care professionals also report feeling insecure about broaching the topic of HIV testing with their patients, particularly those from low-risk backgrounds, citing that discussing HIV testing would be uncomfortable for the patient and might damage the patient-physician bond. 36 Physician were also concerned that they would not receive support from the administration at their health care facility to initiate HIV screening, believing that it would be regarded as more of a burden than a help. Moreover, many physicians did not feel equipped to answer all the patient's questions regarding HIV testing and did not feel that they were capable of convincing the patient that the test should be performed.…”

Section: Physician Awareness and Perceptionmentioning

confidence: 99%

“…In fact, physicians cite that lack of time is the leading reason they have been reticent to implement HIV screening in their practices. 33,36 Health care professionals' concerns about adequate time relates to obtaining written consent before testing each patient for HIV and time to counsel and discuss the implications of a positive or equivocal HIV test result with their patients. This was a particularly important issue to physicians in emergency departments and urgent care settings, where many physicians averaged 10 minutes per patient visit.…”

Section: Systemic Barriersmentioning

confidence: 99%

“…The legal implications of HIV screening continue to make health care providers anxious. 33,36,52 Although national recommendations influence state law, HIV testing laws remain under state jurisdiction. Given that most health care professionals are not directly involved in providing HIV care, many would not be familiar with state laws pertaining to HIV testing.…”

Section: Systemic Barriersmentioning

confidence: 99%

See 3 more Smart Citations

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

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Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.

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Section: Physician Awareness and Perceptionmentioning

confidence: 99%

Section: Physician Awareness and Perceptionmentioning

confidence: 99%

Section: Systemic Barriersmentioning

confidence: 99%

Section: Systemic Barriersmentioning

confidence: 99%

See 2 more Smart Citations

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

Rizza

MacGowan

Purcell

et al. 2012

Mayo Clinic Proceedings

View full text Add to dashboard Cite

show abstract

“…15,16 Barriers to HIV testing fall within several well-described categories: individual level concerns including fear of results, internal and external stigma attached to testing, anxiety waiting for results, lack of recognition of risk status, and low HIV knowledge; provider level barriers such as lack of funding, limited awareness of testing guidelines, and discomfort; and system related barriers such as limited availability of rapid testing. [17][18][19][20] Although data regarding black non-U.S.-born individuals and HIV testing is limited, data from Europe indicate that black immigrants (primarily from sub-Saharan Africa) experience many of the same barriers as native born individuals, including fear of positive test results and its related personal and social consequences, lack of preventive health behavior, and denial of HIV risk. HIVrelated stigma, language barriers, and low HIV knowledge are also common.…”

mentioning

confidence: 99%

All Black People Are Not Alike: Differences in HIV Testing Patterns, Knowledge, and Experience of Stigma Between U.S.-Born and Non–U.S.-Born Blacks in Massachusetts

Ojikutu

Nnaji²,

Sithole

et al. 2013

AIDS Patient Care and STDs

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Non-U.S.-born black individuals comprise a significant proportion of the new diagnoses of HIV in the United States. Concurrent diagnosis (obtaining an AIDS diagnosis in close proximity to an initial diagnosis of HIV) is common in this subpopulation. Although efforts have been undertaken to increase HIV testing among African Americans, little is known about testing patterns among non-U.S.-born black people. A cross-sectional survey was self-administered by 1060 black individuals in Massachusetts (57% non-U.S.-born) to assess self-reported rates of HIV testing, risk factors, and potential barriers to testing, including stigma, knowledge, immigration status, and access to health care. Bivariate analysis comparing responses by birthplace and multivariate logistic regression assessing correlates of recent testing were completed. Non-U.S.-born individuals were less likely to report recent testing than U.S.-born (41.9% versus 55.6%, p < 0.0001). Of those who recently tested, the majority did so for immigration purposes, not because of perceived risk. Stigma was significantly higher and knowledge lower among non-U.S.-born individuals. In multivariate analysis, greater length of time since immigration was a significant predictor of nontesting among non-U.S.-born (adjusted odds ratio [AOR] 0.56, 95% confidence interval [CI] 0.36-0.87). Poor health care access and older age were correlated to nontesting in both U.S.-and non-U.S.-born individuals. Our findings indicate that differences in HIV testing patterns exist by nativity. Efforts addressing unique factors limiting testing in non-U.S.-born black individuals are warranted.

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Be careful of the masquerades: differentiating secondary myelodysplasia from myelodysplastic syndromes in clinical practice

Shallis

Podoltsev

et al. 2018

Ann Hematol

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In patients suspected to have myelodysplastic syndrome (MDS), especially in those patients without cytogenetic abnormalities or blast excess, accurate morphologic review by an expert hematopathologist and meticulous exclusion of other secondary causes of myelodysplasia are vital to establish the diagnosis. Errors in diagnosis can lead to dangerous consequences such as the administration of hypomethylating agents, lenalidomide, or even the use of intensive chemotherapy or allogeneic hematopoietic cell transplantation in patients who do not have an underlying MDS or even a malignant hematopoietic process. Additionally, beyond the possible harm and lack of efficacy of such therapies if the diagnosis of MDS is erroneous, the secondary myelodysplasia and resultant cytopenias are not likely to resolve unless the underlying etiology is identified and addressed. Discriminating a malignant process such as MDS from non-malignant secondary myelodysplasia can be quite challenging, and community hematologists/oncologists should consider referral to specialized physicians (both clinical experts and experienced hematopathologists) if there is any doubt regarding the diagnosis. In this article, we present a representative case series of patients from our own practice who posed diagnostic dilemmas and propose a systematic approach for assessment for secondary causes of myelodysplasia.

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Barriers and Facilitators to Routine HIV Testing: Perceptions from Massachusetts Community Health Center Personnel

Cited by 29 publications

References 15 publications

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

HIV Screening in the Health Care Setting: Status, Barriers, and Potential Solutions

All Black People Are Not Alike: Differences in HIV Testing Patterns, Knowledge, and Experience of Stigma Between U.S.-Born and Non–U.S.-Born Blacks in Massachusetts

Be careful of the masquerades: differentiating secondary myelodysplasia from myelodysplastic syndromes in clinical practice

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