Perspectives from the Field

Sullivan, Kristen; Berger, Miriam B.; Quinlivan, E. Byrd; Parnell, Heather; Sampson, Lynne A.; Clymore, Jacquelyn M.; Wilkin, Aimee M.

doi:10.1177/2325957415617830

Cited by 12 publications

(17 citation statements)

References 41 publications

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“…We also found no statistically significant association between HIV-related training and HIV screening behaviors, in contrast to some prior studies that revealed these associations [41–43]. These results might be explained by unique facility characteristics and other unmeasured factors in our study, such as: lack of facility resources [44], lack of clinic protocols [45], and provider discomfort with discussing sexual history [45, 46].…”

Section: Discussioncontrasting

confidence: 99%

HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017

et al. 2019

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The Southeast accounted for most HIV diagnoses (52%) in the United States in 2015. Primary care providers (PCPs) play a vital role in HIV prevention for at-risk persons and treatment of persons living with HIV. We studied HIV-related training, knowledge, and clinical practices among PCPs in the Southeast to address knowledge gaps to inform HIV prevention strategies. Between April and August 2017, we conducted an on-line survey of a representative sample of PCPs in six Southeast jurisdictions with high rates of HIV diagnoses (Atlanta; Baltimore; Baton Rouge; District of Columbia; Miami; New Orleans). We defined HIV-related training as self-reported completion of any certified HIV/STD course or continuing education in past 24 months (prior to survey completion). We assessed associations between training and HIV testing practices, familiarity with nonoccupational post-exposure prophylaxis (nPEP) and pre-exposure prophylaxis (PrEP), and ever prescribing nPEP or PrEP. There were 820 participants after fielding 4595 surveys (29.6% adjusted response rate). In weighted analyses, 36.3% reported HIV-related training. Using adjusted prevalence ratio (aPR) and confidence intervals (CI), we found that PCPs with HIV-related training (compared to those with no training) were more likely to be familiar with nPEP (aPR = 1.32, 95% CI 1.05, 1.67) and PrEP (aPR = 1.67, 95% CI 1.19, 2.38); and to have ever prescribed PrEP to patients (aPR = 1.75, 95% CI 1.10, 2.78). Increased HIV-related trainings among PCPs in high HIV prevalence Southeast jurisdictions may be warranted. Strengthening nPEP and PrEP familiarity among PCPs in Southeast may advance national HIV prevention goals.

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Section: Discussioncontrasting

confidence: 99%

HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017

et al. 2019

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“…Participants' suggestions to disconnect testing from clinical settings and limit interactions with health care providers (i.e., testing kiosks, HIVST kits, community testing) may assist with reducing negative perceptions about HIV testing experiences. While non-clinical testing may help reduce stigma, it is also important to identify ways to improve linkage to care for people tested in community settings [26,27]. Faith-based and community-based leaders could not only help change norms about HIV as a taboo topic, but also serve as an ongoing local voice for testing promotion and awareness, filling in the gaps between larger public events like health fairs that promote HIV testing.…”

Section: Discussionmentioning

confidence: 99%

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

et al. 2020

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Background: HIV testing programs in the United States aim to reach ethnic minority populations who experience high incidence of HIV, yet 40% of African Americans have never been tested for HIV. The objective of this study is to identify community-based strategies to increase testing among African Americans in both urban and rural areas. Methods: This study conducted focus group discussions (FGDs) informed by community-based participatory research principles to examine African American's concerns and ideas around HIV testing and HIV self-testing. Participants included highly affected (i.e., PLWH, MSM, PWID, low-income, teens and young adults) populations from African American communities in North Carolina, aged 15 years and older. We digitally transcribed and analyzed qualitative data using MAXQDA and axial coding to identify emergent themes.Results: Fifty-two men and women between 15 to 60 years old living in urban (n=41) and rural (n=11) areas of North Carolina participated in focus group discussions. HIV testing barriers differed by HIV testing setting: facilitybased, community-based, and HIV self-testing. In community-based settings, barriers included confidentiality concerns. In facility-based settings (e.g., clinics), barriers included negative treatment by healthcare workers. With HIV self-testing, barriers included improper use of self-testing kits and lack of post-test support. HIV testing facilitators included partnering with community leaders, decentralizing testing beyond facility-based sites, and protecting confidentiality.(Continued on next page)

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“…HIV-related stigma was the second most cited barrier. Five studies reported that providers located in rural areas perceived stigma and stereotypes regarding HIV (Davis et al, 2015; Minniear et al, 2009; Sison et al, 2013; Sullivan et al, 2015; White et al, 2015). Providers believed that HIV-related stigma was still present among physicians and identified ageism as a factor that caused providers to overlook older adult risk for HIV (Davis et al, 2015).…”

Section: Resultsmentioning

confidence: 99%

“…Resource barriers identified in four studies included a lack of dissemination about successful implementation of testing programs in primary care, substance use clinics, and emergency rooms (Simmons et al, 2011; Sullivan et al, 2015. In addition, a lack of patient-friendly literature (Simmons et al, 2011) and rapid test supply shortages (Weis et al, 2009) were barriers to testing.…”

Section: Resultsmentioning

confidence: 99%

“…Health care network characteristics (i.e., factors that determined support networks for providers and access to care for populations) were identified in two studies as barriers to testing. These characteristics included lack of feedback from hospitals about patients diagnosed with HIV (Sullivan et al, 2015, and limited access to health care services in rural areas (Sison et al, 2013).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review of Health Care Provider-Perceived Barriers and Facilitators to Routine HIV Testing in Primary Care Settings in the Southeastern United States

Tan¹,

Black²

2018

Journal of the Association of Nurses in AIDS Care

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Despite efforts to improve HIV screening and testing, many primary care settings do not follow established guidelines. The purpose of our systematic review was to describe health care providers' perceived barriers and facilitators to testing for HIV at poorly used/novel testing sites in the southeastern United States. PubMed, CINAHL, and Embase databases were searched for peer-reviewed studies of providers' perceived barriers and facilitators to routine HIV testing from January 2016 to April 2017 according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Of 708 papers retrieved, 12 met inclusion criteria and were analyzed. Barriers to HIV testing in primary care existed at the societal, organizational, and individual levels. Providers need continuing sexual health education, including HIV and federal guideline updates, and students should have clinical experiences to supplement knowledge about sexual health. Clinic protocols should be updated to meet current policy guidelines.

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Perspectives from the Field

Abstract: These findings can inform efforts to address HIV testing and linkage to care in NC. This approach may provide beneficial insight for other systems of care.

Cited by 12 publications

References 41 publications

HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017

HIV-Related Training and Correlates of Knowledge, HIV Screening and Prescribing of nPEP and PrEP Among Primary Care Providers in Southeast United States, 2017

“Meet people where they are”: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North Carolina

A Systematic Review of Health Care Provider-Perceived Barriers and Facilitators to Routine HIV Testing in Primary Care Settings in the Southeastern United States

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