Perceptions of Patient HIV Risk by Primary Care Providers in High-HIV Prevalence Areas in the Southern United States

Abstract

The southern United States accounted for 52% of new HIV diagnoses in 2015. Visits to primary care providers (PCPs) offer opportunities for routine HIV screening. However, of at-risk persons in the United States who visited a health care provider within the previous year, >75% were not offered a test for HIV. Perceptions of patient population risk by PCPs could offer insight into these missed opportunities, and inform development of HIV testing interventions for PCPs to increase routine screening. During April-October 2017, we conducted online surveys regarding PCP's perceptions of patient HIV risk in six areas of the South with high-HIV prevalence. Surveys queried HIV-related knowledge, beliefs, attitudes, and practices. Free-text responses to the question ''Are there any unique or special risk factors relating to HIV infection in your patient population?'' were analyzed using NVivo for applied thematic analysis. Of 526 respondents, the mean age was 47 years with 65% white, 13% Asian/other, 13% black, 6% Hispanic/Latino; 71% female; 93% straight/heterosexual; and 35% offered HIV screening correctly based on standard of care. Main themes revealed were as follows: (1) provider perceptions of patient risk factors (e.g., ''injection drug use is rampant''), (2) provider perceptions of patient barriers to access and care (e.g., ''concern for parental notification and cost for treatment''), and (3) provider misconceptions of HIV risk and patient stigmatization (e.g., ''I have a low-risk population''). Our findings suggest that PCPs in the South may warrant education regarding local HIV prevalence and routine HIV screening and prevention practices.

Are We Hitting the Target? HIV Pre-Exposure Prophylaxis from 2012 to 2020 in the OPERA Cohort

“…Finally, this analysis did not cover several other sources of disparities in PrEP access, such as socioeconomic status, state policies, or health care provider attitudes or knowledge. 25,26,55,56 In conclusion, although PrEP has been transformative, and its use has been on the rise, significant challenges in its implementation remain. This study revealed that PrEP was under-prescribed to individuals who were at the highest risk for HIV acquisition (13-25 years old, black people, women, in the southern United States).…”

Estimating Gains in HIV Testing by Expanding HIV Screening at Routine Checkups

“…Although the goal of screening more than 80% of US adults for HIV is aspirational, research demonstrates that increased screening in health care settings would be cost effective, even for lower-risk groups, 6 and is key to ending the HIV epidemic. 4 Barriers to HIV testing in primary care settings include health care providers' unfamiliarity with national recommendations, 7,8 continued preference for risk-based screening, 8 assumptions about risk, 9 and HIV stigma. 9 However, studies have shown that improved HIV-testing uptake is possible using interventions such as patient text message reminders 10 and provider electronic medical record prompts.…”

“…4 Barriers to HIV testing in primary care settings include health care providers' unfamiliarity with national recommendations, 7,8 continued preference for risk-based screening, 8 assumptions about risk, 9 and HIV stigma. 9 However, studies have shown that improved HIV-testing uptake is possible using interventions such as patient text message reminders 10 and provider electronic medical record prompts. 11 For example, a 2-fold increase in HIV screening was achieved using a passive electronic medical record reminder at a hospital based, academic primary care practice.…”

Occupational exposures in US obstetrics and gynecology resident physicians

“…5 Although low reporting rates might reflect the perception that patients are at low risk of HIV infection, assessment of risk may be inaccurate. 6 Further, the rising prevalence of hepatitis C infection heightens the concern for transmission of infection during occupational exposures. 7 Lack of time and cumbersome processes were noted, similar to those reported from other surgical trainees.…”