Physician Barriers to Successful Implementation of US Preventive Services Task Force Routine HIV Testing Recommendations

Abstract

In 2006, the US Centers for Disease Control and Prevention issued recommendations supporting routine HIV testing in health care settings for all persons aged 13 to 64 years. Despite these recommendations, physicians are not offering HIV testing routinely. We apply a model that has previously identified 3 central, inter-related factors (knowledge-, attitude-, and behavior-related barriers) for why physicians do not follow practice guidelines in order to better understand why physicians are not offering HIV testing routinely. This model frames our review of the existing literature on physician barriers to routine HIV testing. Within the model, knowledge barriers include lack of familiarity or awareness of clinical recommendations, attitude barriers include lack of agreement with guidelines, while behavioral barriers include external barriers related to the guidelines themselves, to patients, or to environmental factors. Our review reveals that many physicians face these barriers with regards to implementing routine HIV testing. Several factors underscore the importance of determining how to best address physician barriers to HIV testing, including: provisions of the Affordable Care Act that are likely to require or incentivize major payers to cover HIV testing, evidence which suggests that a physician’s recommendation to test for HIV is a strong predictor of patient testing behavior, and data which reveals that nearly 20% of HIV-positive individuals may be unaware of their status. In April 2013, the US Preventive Services Task Force released a recommendation supporting routine HIV testing; strategies are needed to help address ongoing physician barriers to testing.

Hepatitis C Testing Increased Among Baby Boomers Following The 2012 Change To CDC Testing Recommendations

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“…24–26 These studies cite patient, provider, and societal barriers to the implementation of guidelines, which can include a lack of knowledge about the guidelines. 24–27 We acknowledge that such barriers exist and could explain why the post-intervention screening rates we found were not higher. Perhaps if those barriers had been addressed, screening rates in the post-intervention period would have increased even more.…”

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“…In contrast, general HIV testing is not universally routine. Those without identified risk factors are not always screened, and some testing programs require questions about sexual practices and substance use before a test is offered (Zheng, Suneja, Chou, & Arya, 2014).…”

Budgetary Impact of Compliance With STI Screening Guidelines in Persons Living With HIV

“…Many health systems serving PLWH receive financial support via the Ryan White Care Act Program (Title III Early Intervention Services), but funds may be withheld from participating clinics that are consistently non-compliant with recommended screening practices 9 . Despite these measures, compliance with STI screening guidelines remains sub-optimal 3,4,6 and underscores persistent barriers to STI screening including limited clinic resources, lack of awareness of screening needs on the part of the patient and the provider 10-13 , and lack of insurance, which is especially relevant in Medicaid non-expansion states like Alabama. The financial implications of recommended STI screening in PLWH are also not known but understanding budgetary effects is important for the sustainability of recommended STI screening practices.…”