A Routine HIV Screening Program in a South Carolina Community Health Center in an Area of Low HIV Prevalence

Abstract

In 2006, the Centers for Disease Control and Prevention published guidelines for routine HIV screening in healthcare settings. Feasibility studies have demonstrated that screening is effective in high-volume, urban settings, but there are no data for smaller, more rural settings. The main objective of this study was to describe a routine HIV screening program at a community health center in South Carolina serving both urban and rural populations. Margaret J. Weston Community Health Center implemented routine HIV screening using rapid tests at its three locations on December 1, 2006. All individuals utilizing this center over the age of 13 years were screened for HIV unless they opted out. Nurses completed a survey about their experiences with the program. chi(2) tests and logistic regression models were used to analyze the data. In the first 8 months, among 985 eligible visits, 574 (58%) resulted in the patient being screened. The most common reason for refusal was "doesn't think s/he is at risk." Acceptance rates differed significantly by location (p = 0.01), from 62% in the urban site to 47% in the rural site. Other significant predictors of accepting HIV testing were race/ethnicity, age, and method of payment. Three hundred twenty-four (58%) individuals who were tested reported no history of being previously tested for HIV infection. Participation in the screening program was perceived favorably by nurses. This pilot project in a South Carolina community health center demonstrates that implementation of routine HIV screening is acceptable in small healthcare settings and in smaller cities and rural communities in the South.

Routine HIV Testing in Primary Care Clinics: A Study Evaluating Patient and Provider Acceptance

“…Our study findings were similar to other reports of how demographic variables affected willingness to test for HIV (Trotter et al, 2010;Weis et al, 2009). In our study, younger age and African American race were associated with increased acceptance of testing.…”

“…While reasons for the difference in our findings are not clear, there are likely differences in the purposes for a visit to a primary care clinic versus an ED visit that may explain these findings. In the other outpatient study (Weis et al, 2009), females were more likely to accept testing. Further studies evaluating patient test acceptance should evaluate reasons for medical visits.…”

“…In a study of HIV testing in a community health center in South Carolina serving both urban and rural populations, acceptance rates were higher among those from urban areas compared to rural (62% vs. 47%, p 5 .01; Weis et al, 2009). While it is expected that patients from areas of high HIV risk would be more likely to accept testing, multicenter studies should be performed to confirm patient demographics that confer increased acceptance of HIV testing.…”

Factors Affecting Acceptance of Routine Human Immunodeficiency Virus Screening by Adolescents in Pediatric Emergency Departments

“…The higher acceptance of HIV screening among urban versus suburban populations observed in our study has been reported in adults from Michigan and South Carolina [33,35]. Given the heightened attention regarding the HIV epidemic in DC in recent years, including a widely publicized HIV testing campaign and ongoing HIV screening in most adult EDs in the area, where the number of HIV tests has tripled during 2007e2011 [26], it is possible that there is more knowledge and less stigma associated with HIV testing in DC.…”

Provider and Practice Characteristics Associated with Use of Rapid HIV Testing by General Internists

“…We are just beginning to see efforts at offering HIV testing in rural 29 and urban 30 primary care settings. Recent data from community care clinics suggest that implementing rapid HIV testing, together with a systematic method to encourage HIV testing, resulted in an increased number of persons being tested.…”