Online Program

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

Wednesday, November 4, 2015

Julia A. Hill, MPH candidate, Department of Health Behavior, University of North Carolina at Chapel Hill Gillings Global School of Public health, Chapel Hill, NC
Becky White, MD MPH, Department of Medicine, Division of Infections Diseases, University of North Carolina School of Medicine, Chapel Hill, NC
Donald Pathman, MD MPH, Sheps Center for Health Services Research, UNC, Chapel Hill, NC
Ashley Appiagyei, MPH, School of medicine, University of North Carolina School of Medicine, Chapel Hill, NC
Catherine Zimmer, PhD, HW Odum Institute for Research in Social Science, University of North Carolina at Chapel Hill, Chapel Hill, NC
Meheret Mamo, B.S., Department of Health Behavior, University of North Carolina Gillings Global School of Public Health, Chapel Hill, NC
Adaora A. Adimora, MD, MPH, Division of Infectious Diseases, University of North Carolina-Chapel Hill, Chapel Hill, NC
Carol E. Golin, MD, Department of Health Behavior and Health Education and Department of Medicine, University of North Carolina at Chapel Hill Gillings School of Public Health and School of Medicine, Chapel Hill, NC
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.

Learning Areas:

Assessment of individual and community needs for health education
Planning of health education strategies, interventions, and programs

Learning Objectives:
Describe current individual and structural barriers to routine HIV screening for physicians in the southeast

Keyword(s): HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been an investigator on studies related to HIV screening uptake and barriers to care. I have my BA, I am currently an MPH candidate, and have assisted in several studies surrounding HIV.
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.