Low Adoption and Adherence to Routine HIV screening recommendations in the Southeast

National Guidelines recommend that physicians routinely screen adolescent and adult patients ages 13 to 65 for HIV regardless of risks or behaviors. The extent of adoption or adherence to this recommendation in the southeast is currently unknown.  

We developed a novel questionnaire based on the Awareness to Adherence Dissemination and Implementation Guideline Framework. The Framework posits that physicians first become aware of the recommendation, agree with the recommendation, adopt and adhere to the recommendation. The questionnaire was mailed (using the Dillman method) to 558 randomly selected family and internal medicine physicians in North Carolina from October 2014-present. Fifty percent (N=268) of eligible participants (N=536) responded.

The majority of respondents were white male physicians who worked in single or multi-group urban specialty practices.  Sixty-three percent were aware, 54% agreed and 27% adopted the recommendation. Most (60%) preferred risk-based screening. Only 15% offered HIV screening (adhered) during a new patient visit. Physicians who were aware or who agreed were 2-3 times more likely respectively to offer HIV screening to their patients (OR 2.45 for aware, p=0.030; OR 3.00 for agreed,p=0.005). Physicians who agreed were 6 times more likely to adopt routine HIV screening (OR 6.03, p<.001). Although 40% believed their patients would object to being offered screening, 70% would screen if third party payers universally reimbursed for it.

These findings suggest that educational programs and policies to increase provider knowledge, change beliefs and reduce financial barriers may move primary care physicians from awareness to adherence to routine HIV screening recommendations.