Understanding provider barriers and facilitators to routine HIV testing

Issues: Recent CDC guidelines have recommended health care providers routinely provide HIV screening for patients aged 13 to 64. Implementation of the guidelines has been met by mixed success. Beyond identifying barriers to implementation, there is a need to evaluate programs that facilitate integration of the testing process into primary care

Description: This paper will report on a nominal group study of providers at 10 clinical sites in Bronx, New York, one of the highest seroprevalence communities in the US. The clinical sites received an educational intervention, the ACTS (Advise, Consent, Test, Support) program designed to streamline the implementation of routine testing in clinical settings. HIV screening rates increased significantly from baseline (on average from 10 to 25%). To improve HIV testing even further, a nominal group study was conducted to assess the barriers and facilitators of implementing routine screening. Participants generated lists of barriers and facilitators and then independently rank ordered the items according to their experience. Group totals were obtained.

Lessons Learned: The top three barriers reported by the participants were patient resistance to HIV testing; lack of integration into practice routines; and negative attitudes/stigma. The top facilitators were the simplicity of screening procedures, buy-in from staff and administration, recognizing the need for HIV testing in the community and receiving ACTS training and related support.

Recommendations: Programs seeking to implement routine HIV testing into clinical practice should address the multiple levels of influence determining successful practice change: patient and provider beliefs, structural factors and social norms.