Physician and Nurse Perspectives on Implementation of Universal Adult HIV Screening Guidelines in the Indian Health Service

Division of Epidemiology and Disease Prevention, US Indian Health Service, Albuquerque, New Mexico 87110, USA.
Journal of public health management and practice: JPHMP (Impact Factor: 1.47). 09/2010; 16(5):450-6. DOI: 10.1097/PHH.0b013e3181bdec1a
Source: PubMed


We sought to determine attitudes and needs among health care providers in the Indian Health Service toward implementing routine human immunodeficiency virus (HIV) screening among 13- to 64-year-olds as per Centers for Disease Control and Prevention (CDC) guidelines.
We surveyed a random sample of Indian Health Service physicians and nurses by e-mail and telephone interview. A total of 205 eligible respondents (response rate = 70%) completed the survey.
A majority (58%) of respondents were familiar or somewhat familiar with the 2006 CDC guidelines on HIV screening for 13- to 64-year-olds. A proportion of respondents (43%) felt that community HIV prevalence was below the 0.1% threshold the CDC recommends to initiate screening. Respondents supported routine, rather than solely risk-based HIV testing (70%) and stated that HIV screening would be realistic in their health facility (51%). Respondents felt that they needed special qualification to offer an HIV test (49%) or to notify a patient of a "reactive" HIV test result (67%).
A majority of Indian Health Service physicians and nurses support the CDC HIV screening guidelines. Providers need more information and training on HIV screening guidelines, implementation strategies, and relevant state HIV regulations.

Download full-text


Available from: John T Redd, Nov 10, 2014
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To evaluate the knowledge and attitudes of residents and attendings in emergency medicine (EM) and internal medicine (IM) about HIV. An electronic anonymous 41-question survey of IM and EM physicians at the University of Cincinnati Academic Health Center. The survey was completed by 232 physicians (71.6%). EM residents were more likely to routinely offer HIV testing compared to IM residents (60.7% vs. 27.8%, P = 0.0009). Overall, there was no difference in offering HIV testing by sex (32% vs. 35.6%) or by residents versus attendings (33.8% vs. 33.3%). Only 70 physicians (30.9%) were aware of current CDC recommendations of HIV screening with attendings more knowledgeable than residents (41.7% vs. 26%, P = 0.017). EM and IM residents and attendings fail to offer HIV testing or assess for HIV transmission risk factors with sufficient frequency. There is also a gap in knowledge of the current CDC recommendations.
    Journal of the International Association of Physicians in AIDS Care (JIAPAC) 02/2012; 11(2):101-8. DOI:10.1177/1545109711430165
  • [Show abstract] [Hide abstract]
    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.
    Journal of the International Association of Providers of AIDS Care 01/2014; 13(3). DOI:10.1177/2325957413514276
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background:Despite the 2006 US Centers for Disease Control and Prevention (CDC) recommendations for routine HIV testing in health care settings, many persons remain untested.Purpose:To determine physician barriers to HIV testing, we surveyed primary care physicians in community health centers in a high HIV prevalence city.Methods:Primary care physicians were invited via e-mail to participate in a Web-based survey. One hundred and thirty-seven physicians participated (response rate: 43.9%).Results:Fifty-five physicians (41.0%) were unaware of updated CDC HIV-testing recommendations. Physicians were unaware that testing should be routinely offered in primary care settings caring for adolescents (62 physicians, 45.6%) and primary care settings caring for adults (33, 24.3%). Physicians were also unaware that teenage years patients aged 13 to 17 years (68, 49.6%) and adult patients aged 18 to 64 years (40, 29.2%) should be routinely HIV tested.Conclusion:With the new 2013 US Preventive Services Task Force recommendations to support routine HIV testing, it is critical to address ongoing physician HIV-testing barriers to mitigate the HIV epidemic.
    Journal of the International Association of Providers of AIDS Care 01/2014; 13(4). DOI:10.1177/2325957413517140
Show more