Why don't physicians test for HIV? A review of the US literature.
OBJECTIVE
In its 2006 HIV testing guidelines, the Centers for Disease Control and Prevention (CDC) recommended routine testing in all US medical settings. Given that many physicians do not routinely test for HIV, the objective of this study was to summarize our current understanding of why US physicians do not offer HIV testing.


METHODS
A comprehensive review of the published and unpublished literature on HIV testing barriers was conducted.


METHODS
A literature search was conducted in Pubmed using defined search terms. Other sources included Google, recent conference abstracts, and experts in the field. Studies were divided into three categories: prenatal; emergency department; and other medical settings. These categories were chosen because of differences in physician training, practice environment, and patient populations. Barriers identified in these sources were summarized separately for the three practice settings and compared.


RESULTS
Forty-one barriers were identified from 17 reports. Twenty-four barriers were named in the prenatal setting, 20 in the emergency department setting, and 23 in other medical settings. Eight barriers were identified in all three categories: insufficient time; burdensome consent process; lack of knowledge/training; lack of patient acceptance; pretest counselling requirements; competing priorities; and inadequate reimbursement.


CONCLUSIONS
US physicians experience many policy-based, logistical, and educational barriers to HIV testing. Although some barriers are exclusive to the practice setting studied, substantial overlap was found across practice settings. Some or all of these barriers must be addressed before the CDC recommendation for routine HIV testing can be realized in all US medical settings.
Burke
Ryan C
RC
Bureau of HIV/AIDS Prevention and Control, New York City Department of Health and Mental Hygiene, 346 Broadway, New York, NY 10013, USA. rburke@health.nyc.gov
Sepkowitz
Kent A
KA
Bernstein
Kyle T
KT
Karpati
Adam M
AM
Myers
Julie E
JE
Tsoi
Benjamin W
BW
Begier
Elizabeth M
EM
D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D002487:Centers for Disease Control and Prevention, U.S.; D002983:Clinical Competence; D003955:Diagnostic Tests, Routine / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D006801:Humans; D007258:Informed Consent; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis; D011295:Prenatal Care / Q000592:standards / Q000706:statistics & numerical data; D014481:United States