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Barriers and Facilitators to Routine HIV Testing in VA Primary Care

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ABSTRACT

BACKGROUND

Approximately 21% of the 1.1 million HIV-infected persons in the United States are unaware of their HIV status. The Centers for Disease Control (CDC) recommend routine opt-out HIV testing for all patients aged 13–64. Yet little is known about patient and provider perspectives on routine HIV testing.

OBJECTIVE

We sought to understand patient and provider perspectives on the adoption of routine HIV testing within the US Department of Veterans Affairs.

DESIGN

We conducted four focus groups with patients and two focus groups with primary care providers to explore perceptions of, communication about, and barriers and facilitators to routine HIV testing in primary care.

PARTICIPANTS

Convenience sample of patients and primary care providers at two geographically diverse Veterans’ Affairs Medical Centers.

APPROACH

We conducted grounded thematic analyses of transcribed audio-recordings of focus groups to identify major themes, identifying similarities and differences between patient and provider perspectives.

MAIN RESULTS

Patients and providers concurred that implementation of routine HIV testing, treating HIV like other chronic diseases, and removing requirements for written informed consent and pre-test counseling were of benefit to patients and to public health. Patients, however, wished to have HIV testing routinely offered by providers so that they could decide whether or not to be tested. Veterans also stated that routinizing testing would help destigmatize HIV. Six steps to communicating about routine testing (“the 6 R’s”) were identified.

CONCLUSIONS

Patients and providers appear ready for implementation of routine HIV testing. However, providers should use patient-centered communication strategies to ease patients’ concerns about confidentiality and stigma associated with HIV disease.

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Acknowledgements

A version of this paper was presented at the VA Health Services Research and Development Annual Meetings, February 2008, and at the Society for General Internal Medicine Meetings, April 2008. Funding for this study was provided by the Department of Veterans Affairs, Health Services Research and Development Service grant no. RRP 07–281. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs. We would like to thank Dr. Wendell Ching and Dr. James Schlosser for their assistance in conducting this study, as well as research assistants, Linda McCoy, Anne Taylor and Lee Ann Lowe.

Conflict of interest

The authors have no conflict of interest with the research presented in this paper.

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Authors and Affiliations

  1. Center for Health Quality, Outcomes & Economic Research, Edith Nourse Rogers Veterans Affairs Medical Center, 200 Springs Road (152), Bedford, MA, 01730, USA

    Barbara G. Bokhour PhD, Jeffrey L. Solomon PhD & Allen L. Gifford MD

  2. Boston University School of Public Health, Boston, MA, USA

    Barbara G. Bokhour PhD & Allen L. Gifford MD

  3. Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA

    Herschel Knapp PhD & Steven M. Asch MD

Authors
  1. Barbara G. Bokhour PhD
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  2. Jeffrey L. Solomon PhD
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  3. Herschel Knapp PhD
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  4. Steven M. Asch MD
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  5. Allen L. Gifford MD
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Corresponding author

Correspondence to Barbara G. Bokhour PhD.

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Bokhour, B.G., Solomon, J.L., Knapp, H. et al. Barriers and Facilitators to Routine HIV Testing in VA Primary Care. J GEN INTERN MED 24, 1109–1114 (2009). https://doi.org/10.1007/s11606-009-1078-6

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  • DOI: https://doi.org/10.1007/s11606-009-1078-6

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