title: Barriers to routine HIV testing among Massachusetts community health center personnel.
abstract: OBJECTIVE
  We assessed the extent to which Centers for Disease Control and Prevention (CDC) recommendations have influenced routine HIV testing among Massachusetts community health center (CHC) personnel, and identified specific barriers and facilitators to routine testing.
  
  
  METHODS
  Thirty-one CHCs were enrolled in the study. We compared those that did and did not receive funding support from the federal Ryan White HIV/AIDS Program. An anonymous survey was administered to a maximum five personnel from each CHC, including a senior administrator, the medical director, and three medical providers. Overall, 137 participants completed the survey.
  
  
  RESULTS
  Among all CHCs, 53% of administrators reported having implemented routine HIV testing at their CHCs; however, only 33% of medical directors/providers reported having implemented routine HIV testing in their practices (p<0.05). Among administrators, 60% of those from Ryan White-supported CHCs indicated that both they and their CHCs were aware of CDC's recommendations, compared with 27% of administrators from non-Ryan White-supported CHCs. The five most frequently reported barriers to the implementation of routine HIV testing were (1) constraints on providers' time (68%), (2) time required to administer counseling (65%), (3) time required to administer informed consent (52%), (4) lack of funding (35%), and (5) need for additional training (34%). In a multivariable logistic regression model, the provision of on-site HIV testing by nonmedical staff resulted in increased odds of conducting routine HIV testing (odds ratio [OR] = 9.84, 95% confidence interval [CI] 1.77, 54.70). However, the amount of time needed to administer informed consent was associated with decreased odds of providing routine testing (OR=0.21, 95% CI 0.05, 0.92).
  
  
  CONCLUSIONS
  Routine HIV testing is not currently being implemented uniformly among Massachusetts CHCs. Future efforts to increase implementation should address personnel concerns regarding time and staff availability.
authors: Harvard Medical School/Massachusetts General Hospital, Department of Psychiatry, Boston, MA, USA. mmimiaga@fenwayhealth.org
authors: Matthew J
authors: MJ
authors: Mimiaga
authors: Carey V
authors: CV
authors: Johnson
authors: Sari L
authors: SL
authors: Reisner
authors: Rodney
authors: R
authors: Vanderwarker
authors: Kenneth H
authors: KH
authors: Mayer
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D002487:Centers for Disease Control and Prevention, U.S.; D016009:Chi-Square Distribution; D003151:Community Health Centers / Q000458:organization & administration*; D005260:Female; D015658:HIV Infections / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology