Knowledge, Attitudes, and Ordering Patterns for Routine HIV Screening among Resident Physicians at an Urban Medical Center

Abstract

Background: We sought to measure resident physician knowledge of HIV epidemiology and screening guidelines, attitudes toward testing, testing practices, and barriers and facilitators to routine testing. Methods: Resident physicians in internal medicine, pediatrics, obstetrics and gynecology, and emergency medicine were surveyed. Results: Overall response rate was 63% (162 of 259). Half knew details of the HIV screening guidelines, but few follow these recommendations. Less than onethird reported always or usually performing routine testing. A significant proportion reported only sometimes or never screening patients with risk factors. This was despite a strong belief that HIV screening improves patient care and public health. The most common barriers to testing were competing priorities and forgetting to order the test. Elimination of written consent and electronic reminders was identified as facilitators to routine testing. Although an institutional policy assigns responsibility for test notification and linkage of HIV-positive patients to care to the HIV care program, only 29% were aware of this. Conclusions: Few resident physicians routinely screen for HIV infection and some don't test patients with risk factors. While competing priorities remain a significant barrier, elimination of written consent form and electronic reminders has facilitated testing. Increasing the awareness of policies regarding test notification and linkage to care may improve screening.

Healthcare providers’ knowledge, readiness, prescribing behaviors, and perceived barriers regarding routine HIV testing and pre-exposure prophylaxis in DeLand, Florida

“…We are still seeing this disconnect between provider knowledge/awareness and prescribing behaviors, even for straightforward state-mandated practices such as HIV testing of pregnant women. Similar to other studies, competing priorities during visits 21–25,28,53 and providers’ perceptions that patients are at low risk for infection or do not engage in high-risk behaviors 20,21,23–30 were the most common barriers to DeLand providers ordering HIV testing. A systematic review published in 2017 shows that routine testing of pregnant women is not only cost-effective but also cost-saving.…”

“…Although guidance is clear and has been in place since 2006, regarding HIV testing, 17–19 and since 2014 regarding PrEP prescription recommendations, 42 this study demonstrates in DeLand, Florida similar results as those seen throughout other studies across the nation. 53,54 For example, three-quarters of providers were aware of the Florida statute requiring HIV testing of pregnant women during their first and third trimesters. Of the remaining quarter, only one provider mentioned not treating pregnant women.…”

A survey of syphilis knowledge among medical providers and students in Rhode Island

“…Similar surveys have previously been developed for other infectious diseases, particularly for HIV. [13][14][15] While a small number of syphilis knowledge surveys have previously been developed, many have been limited in scope, as either secondary to HIV knowledge questionnaires or part of a broader STI survey, or otherwise focused on at-risk individuals rather than providers. [16][17][18][19][20][21] Work that more closely mirrors our own has been performed in Brazil with respect to maternal and congenital syphilis by Dos Santos et al 22,23 The two 2015 studies targeted obstetricians/nurses and pediatricians, respectively, in municipal maternity hospitals in Brazil in an area with a high incidence of congenital syphilis.…”

Investigating Barriers in HIV-Testing Oncology Patients: The IBITOP Study, Phase I

“…This would also circumvent the barrier of "no time," cited by four physicians. The reason of "forgetting" could be addressed by using pop-up reminders in the patients' electronic medical records for the team to test for HIV at diagnosis or before commencing immunosuppressive treatment [32]. Opt-out testing, in which testing is performed routinely unless the patient expressly refuses, would also address the barrier of forgetting, because HIV would be part of the baseline patient work-up.…”