What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary Care Physicians in the Southeastern United States

Abstract

The Centers for Disease Control and Prevention have recommended routinely testing patients (aged 13–64) for HIV since 2006. However, many physicians do not routinely test. From January 2011- March 2012, we conducted 18 in-depth individual interviews and explored primary care physicians’ perceptions of barriers and facilitators to implementing routine HIV testing in North Carolina. Physicians’ comments were categorized thematically and fell into five groups: policy, community, practice, physician and patient. Lack of universal reimbursement was identified as the major policy barrier. Participants believed endorsement from the United States Preventive Services Tasks Force would facilitate adoption of routine HIV testing policies. Physicians reported HIV/AIDS stigma, socially conservative communities, lack of confidentiality, and rural geography as community barriers. Physicians believed public HIV testing campaigns would legitimize testing and decrease stigma in communities. Physicians cited time constraints and competing clinical priorities as physician barriers that could be overcome by delegating testing to nursing staff. HIV test refusal, low HIV risk perception, and stigma emerged as patient barriers. Physicians recommended adoption of routine HIV testing for all patients to facilitate and destigmatize testing. Physicians continue to experience a variety of barriers when implementing routine HIV testing in primary care settings. Our findings support multilevel approaches to enhance physician routine HIV testing in primary care settings.

The Continuum of HIV Care in Rural Communities in the United States and Canada: What Is Known and Future Research Directions

“…Only approximately 10% reported adhering to the recommendation. 55,56 Barriers identified by these physicians included current HIV-related policies (eg, third-party reimbursement, requirement for written consent), stigma and lack of confidentiality in nonurban communities, practice financial environment, physician attitudes, and patient acceptance. 56 …”

Clinical outcomes of HIV care delivery models in the US: a systematic review

“…However, persons at risk for HIV, and therefore potential candidates for pre-exposure prophylaxis (PrEP), typically receive care from primary care clinicians, who may feel discomfort with prescribing PrEP and that it may not fall within their clinical purview (Hoffman et al, 2015; Krakower, Ware, Mitty, Maloney, & Mayer, 2014). The literature also indicates educational (i.e., lack of knowledge or misperceptions) (Sison et al, 2013) and financial barriers (i.e., inadequate reimbursement) (Korthuis et al, 2011; White et al, 2015) to primary care physicians offering HIV testing and counseling. Many primary care physicians remain unaware of CDC’s HIV testing recommendations (Arya et al, 2014), and increased educational and outreach opportunities not only for HIV testing but also for HIV management may be required.…”

Physician Preferences for Physician-Targeted HIV Testing Campaigns

“…In fact, a recent qualitative study published by White et al found that physicians find it advantageous for patients to ask for the HIV test. 23 Such patient-initiated discussions could help overcome some of physicians’ interpersonal barriers that hinder HIV testing discussions. 17 Furthermore, patients who are more involved and actively participate in their physicians’ appointments are met with more patient-centered communication from and are more favorably perceived by their physicians.…”

“…Notably, a 2014 study reported that physicians believe public HIV testing campaigns can “legitimize” testing and decrease stigma. 23 Physicians appear to be open to methods of promoting HIV testing that do not ostracize or profile patients but that indicate HIV as an acceptable topic of discussion for all patients.…”