Routine HIV test expansion: Overcoming barriers to increase HIV testing at community health centers

Background: Public health professionals contend that finding ways to implement routine HIV testing policies in Community Health Centers (CHC) is critical to curbing the proliferation of HIV in the U.S. However, few CHC offer routine HIV testing. The consequence is that racial minorities who make up 67% of CHC patients, and who are also the population among whom the rate of new HIV cases is largest, are not routinely tested; thus, early detection is reduced, linkage to treatment is delayed and transmission continues. This study measured (1) current HIV test practices, (2) assessed awareness of the Centers for Disease Control (CDC) recommendation for routine testing, and (3) identified barriers and opportunities to implementing routine testing at CHC and hospitals.

Methods: We conducted 70 surveys, 20 individual interviews, and 10 focus groups among staff working in CHC and hospitals located within the City of Los Angeles' most impoverished communities.

Results: 30% of CHC and Hospitals did not offer HIV tests; and, only 13% offered routine HIV tests. Overall awareness of the CDC recommendation for routine HIV testing was lower than expected. Cost is the major barrier to implementing routine tests. Additional barriers include time to conduct tests, education about testing protocols, and the perception that routine tests are unnecessary based on the patient community served.

Conclusion: To increase the implementation of routine testing, training programs must be accessible and offer explicit instructions on how to test, make linkages to treatment and, most important, how to receive test reimbursements.