General practitioners’ barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study

Abstract

European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UK guidelines recommend performing a ‘routine offer of HIV testing’ in primary care where HIV prevalence exceeds 2 in 1000. Implementation of new provider-initiated HIV testing strategies in general practice is limited, while the numbers of undiagnosed and late for care HIV patients remain high. We have explored Dutch general practitioners’ barriers to and facilitators of both strategies. We combined semi-structured in-depth interviews with focus groups. Nine general practitioners – key informants of sexually transmitted infection/HIV prevention and control – were selected for the interviews. Additionally, we organised focus groups with a broad sample of general practitioners (n = 81). Framework analysis was used to analyse the data. Various barriers were found, related to (1) the content of the guidelines (testing the right group and competing priorities in general practice), (2) their organisational implementation (lack of time, unclear when to repeat the HIV test and overlong list of ICs) and (3) the patient population (creating fear among patients, stigmatising them and fear regarding financial costs). Multiple general practitioners stated that performing a sexual risk assessment of patients is important before applying either strategy. Also, they recommended implementing the IC-guided approach only in high-prevalence areas and combining HIV tests with other laboratory blood tests. General practitioners tend to cling to old patterns of risk-based testing. Promoting awareness of HIV testing and educating general practitioners about the benefits of new provider-initiated HIV testing strategies is important for the actual uptake of HIV testing.

HIV testing within general practices in Europe: a mixed-methods systematic review

“…The guidance released by the HIV in Europe Initiative in 2012 recommends the provision of HIV testing for patients presenting with indicator diseases, defined as co-morbid diseases afflicting HIV infected persons disproportionally [ 41 ]. GPs in the Netherlands ( N = 81) considered that the list of HIV indicator diseases as too long and not applicable in its current form in primary care [ 42 ]. In a survey among GPs in the UK ( N = 80), the majority indicated that it would be feasible to routinely offer HIV testing to patients with the following HIV indicator diseases: STIs and multidermatomal or recurrent herpes zoster infection.…”

“…Information about the patient origins in HIV endemic countries was registered for 56% of the patients from the migrant group. Joore, 2016 [ 42 ] Netherlands Qualitative study with FGDs and in depth-interviews, 2014 6 FGDs f including 81 GPs and in- depth interviews with 9 key-informants The list of IC is too long and therefore not applicable in its current form in primary care. Joore, 2016 [ 45 ] Netherlands Retrospective observational study making use of a consultation-based data set from the Sentinel Practices of the Primary Care Database, 2008–2013, combined with a questionnaire survey among GPs 907 STI-related consultations in high risk groups No HIV test in 34% of the STI-related consultations in patients from high risk groups.…”

“…Offering an HIV test without a patient’s specific request, an immediate diagnostic need, or outside of ‘a window of opportunity’ such as a blood test for other clinical indications or a sexual or reproductive health consultation caused feelings of discomfort among GPs, who expressed concern with regard to the patient’s potential reaction [ 42 , 48 , 49 ]. Therefore, HIV testing practices were generally limited to the above-mentioned situations [ 29 , 32 , 35 – 37 , 40 , 49 ].…”

Predictors Of Provider-Initiated Hiv Testing In Heterosexuals At Increased Risk Of Hiv (Het) In Puerto Rico: Data From Nhbs-Het Cycle 2016

“…Such barriers include lack of time during routine visits, the healthcare provider's beliefs that his or her patients would feel uncomfortable discussing HIV infection, a patient's belief that his or her previous results (prior to the last 12-months) remain valid, and the provider's (or patient's) sense that such a conversation would be inappropriate because of a poor doctor-patient relationship. [9][10][11][12][13] However, further studies have reported that such barriers might be overcome through provider initiatives such as adopting a sensitive attitude when engaging patients in discussing HIV testing and offering educational reinforcement on HIV. 14,15 The burden of HIV infection in heterosexual individuals at high risk in PR and the current low HIV testing uptake highlight the need for understanding behavioral surveillance data on the predictors of PIHT.…”

Yonder: Case finding, HIV testing, trainee inductions, and waiting rooms

“…A Dutch research team sought to find out what GPs thought of this, completing interviews and focus groups across the country. 2 Various barriers were found, including competing priorities in real-world general practice, uncertainty about when to repeat the test, and the fears about stigma and financial costs. Many GPs considered sexual risk assessment important regardless of the strategy and there was a tendency to favour the old patterns of risk-based testing.…”