Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

DeMarco, Rosanna; Gallagher, Donna; Bradley-Springer, Lucy; Jones, Sande Gracia; Visk, Julie

doi:10.1016/j.outlook.2011.06.002

Cited by 22 publications

(12 citation statements)

References 32 publications

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“…When the clinic was particularly busy, when they were running behind schedule, or when emergent issues arose, the testers felt there was insufficient time to perform the test. Lack of time has been cited in the literature as a barrier to routine testing (Demarco, Gallagher, Bradley-Springer, Jones, & Visk, 2012; Thornton et al, 2012). In a recent study of routine HIV testing in a primary care clinic that reported a low rate of HIV testing (8.75%), a survey of health care workers who participated in testing revealed that busy days or days when the clinic was short-staffed resulted in fewer tests being offered (Valenti, Szpunar, Saravolatz, & Johnson, 2012).…”

Section: Discussionmentioning

confidence: 99%

Integrating Routine HIV Screening Into a Primary Care Setting in Rural North Carolina

Harmon

Collins-Ogle

Bartlett

et al. 2014

Journal of the Association of Nurses in AIDS Care

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African Americans living in the southern United States are disproportionately affected by HIV infection. Identifying and treating those who are infected is an important strategy for reducing HIV transmission. A model for integrating rapid HIV screening into community health centers was modified and used to guide implementation of a testing program in a primary care setting in a small North Carolina town serving a rural African American population. Anonymous surveys were completed by 138 adults who were offered an HIV test; of the 100 (72%) who accepted an HIV test, 61% were female and 89.9% were African American. Among those African American survey respondents who accepted an offer of testing, 58% were women. The most common reason for declining an HIV test was lack of perceived risk; younger patients were more likely to get tested. Implementation of the testing model posed challenges with time, data collection, and clinic flow.

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Section: Discussionmentioning

confidence: 99%

Integrating Routine HIV Screening Into a Primary Care Setting in Rural North Carolina

Harmon

Collins-Ogle

Bartlett

et al. 2014

Journal of the Association of Nurses in AIDS Care

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“…It is within this context that many of those infected seek treatment at public sector facilities, where counselling forms an important part of their on-going testing and treatment schedule (Kanekar, 2011). This interaction is conducted by nurses, who are at the forefront of combatting these coinfections (DeMarco, Gallagher, Bradley-Springer, Jones, & Visk, 2012). Extensive training was undertaken to not only ensure that accurate information was provided to patients, but to ensure that they all receive quality services (Roura, Watson-Jones, Kahawita, Ferguson, & Ross, 2013).…”

Section: Introductionmentioning

confidence: 99%

Nurses perceptions about their behavioural counselling for HIV/AIDS, STIs and TB in eThekwini Municipality clinics KwAZulu-Natal, South Africa

Mntlangula

Khuzwayo

Taylor

2017

Health SA Gesondheid

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Background: HIV and AIDS, sexually transmitted infections (STIs) and tuberculosis (TB) are common co-infections in South Africa, and constitute major public health problems. Nurses have frequent contact with HIV positive and TB co-infected patients, their counselling behaviour being influenced by knowledge about counselling as well as their beliefs, attitudes and perceptions about barriers to counselling.Purpose: The purpose of the survey was to assess the knowledge, attitude and beliefs of nurses about behavioural counselling for HIV and AIDS, STIs and TB (HAST) in three areas of the eThekwini Municipality.Results: This was a quantitative descriptive cross sectional study, with stratified sampling being used to select 87 nurses from 24 PHC facilities who completed self-administered questionnaires. The most significant factors associated with the knowledge, attitude and beliefs of nurses about counselling behaviour were their age and level of education. Nurses were well informed about counselling behaviour (mean scores 4.1/5). However, the potential barriers to implementing effective counselling behaviour included their negative perceptions about counselling in HAST.Conclusion: There is an urgent need for further studies to explore barriers to counselling behaviour and how these can be addressed by the nurses and their managers.

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“…ED crowding is a growing national crisis and is associated with workflow challenges [13][14][15]. Lack of clinician time is a commonly cited barrier to implementing initiatives like HIV testing; it is likely one of the major challenges in complying with the current legislative mandate in New York State [35]. In past studies, ED physicians reported spending less than ten minutes with each patient, illustrating the complexity of implementing mandatory non-targeted HIV testing [36].…”

Section: Discussionmentioning

confidence: 99%

An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

Schnall¹,

Liu²,

Sperling

et al. 2014

Appl Clin Inform

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SummaryObjective: Based on US. Centers for Disease Control and Prevention recommendations, New York State enacted legislation in 2010 requiring healthcare providers to offer non-targeted human immunodeficiency virus (HIV) testing to all patients aged 13–64. Three New York City adult emergency departments implemented an electronic alert that required clinicians to document whether an HIV test was offered before discharging a patient. The purpose of this study was to assess the impact of the electronic alert on HIV testing rates and diagnosis of HIV positive individuals.Methods: During the pre-intervention period (2.5–4 months), an electronic “HIV Testing” order set was available for clinicians to order a test or document a reason for not offering the test (e.g., patient is not conscious). An electronic alert was then added to enforce completion of the order set, effectively preventing ED discharge until an HIV test was offered to the patient. We analyzed data from 79,786 visits, measuring HIV testing and detection rates during the pre-intervention period and during the six months following the implementation of the alert.Results: The percentage of visits where an HIV test was performed increased from 5.4% in the pre-intervention period to 8.7% (p<0.001) after the electronic alert. After the implementation of the electronic alert, there was a 61% increase in HIV tests performed per visit. However, the percentage of patients testing positive per total patients-tested was slightly lower in the post-intervention group than the pre-intervention group (0.48% vs. 0.55%), but this was not significant. The number of patients-testing positive per total-patient visit was higher in the post-intervention group (0.04% vs. 0.03%).Conclusions: An electronic alert which enforced non-targeted screening was effective at increasing HIV testing rates but did not significantly increase the detection of persons living with HIV. The impact of this electronic alert on healthcare costs and quality of care merits further examination.Citation: Schnall R, Liu N, Sperling J, Green R, Clark S, Vawdrey D. An electronic alert for HIV screening in the emergency department increases screening but not the diagnosis of HIV. Appl Clin Inf 2014; 5: 299–312 http://dx.doi.org/10.4338/ACI-2013-09-RA-0075

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Recommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions

Cited by 22 publications

References 32 publications

Integrating Routine HIV Screening Into a Primary Care Setting in Rural North Carolina

Integrating Routine HIV Screening Into a Primary Care Setting in Rural North Carolina

Nurses perceptions about their behavioural counselling for HIV/AIDS, STIs and TB in eThekwini Municipality clinics KwAZulu-Natal, South Africa

An Electronic Alert for HIV Screening in the Emergency Department Increases Screening but not the Diagnosis of HIV

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