207395 Routine HIV testing in Massachusetts community health centers: Perceived barriers and strategies to improve screening rates

Wednesday, November 11, 2009: 10:45 AM

Carey V. Johnson, MS , The Fenway Institute, Fenway Health, Boston, MA
Matthew J. Mimiaga, ScD, MPH , Psychiatry, Harvard Medical School and The Fenway Institute, Fenway Health, Boston, MA
Rodney VanDerwarker, MPH , The Fenway Institute, Boston, MA
Kenneth Mayer, MD , Brown University/Miriam Hospital and The Fenway Institute, Fenway Health, Boston, MA
BACKGROUND: Since 2006, the CDC has recommended routine, voluntary HIV testing for all persons aged 13-64 in all healthcare settings.

METHODS: This study examined HIV testing among 31 Massachusetts community health centers (CHCs), to evaluate whether CDC recommendations have influenced routine HIV testing in these environments. Representative of the state's 52 CHCs, 15 received Ryan White Program funding for HIV services. A maximum 5 personnel from each CHC, including a senior-level administrator, medical director, and three medical providers completed an anonymous survey (N=137). A qualitative interview was administered to one of the senior personnel from each CHC (N=30). Survey data were analyzed for statistical independence. Interview responses were examined using content analysis.

RESULTS: Among administrators and medical directors/providers, 53% and 33% report having implemented routine HIV testing at their CHCs and practices, respectively (P<0.05). Qualitative data revealed the following themes as barriers to routine HIV testing: 1) Time: constraints on provider's time, time to administer counseling and informed consent; 2) Resources: lack of funding, staff and space to screen all patients; 3) Discomfort: patient, provider and community discomfort with routine HIV testing; 4) Knowledge: inconsistent levels of awareness and implementation of CDC recommendations; and 5) State Policy: perceived incompatibility with Massachusetts testing policy.

CONCLUSIONS: Strategies to improve routine HIV testing rates among Massachusetts CHCs include release of state-level guidelines; organizational buy-in; designation of a CHC routine testing coordinator who reports to senior management; patient, provider and community education; and a collaborative analysis to integrate routine testing within existing CHC activities.

Learning Objectives:
1. Describe current HIV testing practices within primary care settings among Massachusetts community health centers. 2. Evaluate the extent to which the 2006 CDC recommendations regarding routine HIV testing have influenced HIV testing within these care environments. 3. Compare HIV testing rates and the implementation of routine HIV testing between those Massachusetts health centers that do and do not receive funding support from the federal Ryan White HIV/AIDS Program. 4. List 5 barriers to routine HIV testing articulated by key health center personnel through surveys and interviews. 5. Discuss strategies to improve routine HIV testing rates within community health centers.

Keywords: HIV/AIDS, HIV Interventions

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: ScD Harvard, PI of the current study
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Contemporary Issues in HIV Testing
See more of: HIV/AIDS