Factors affecting clinician educator encouragement of routine HIV testing among trainees.
BACKGROUND
Adoption of CDC recommendations for routine, voluntary HIV screening of all Americans age 13–64 years has been slow. One method to increase adherence to clinical practice guidelines is through medical school and residency training.


OBJECTIVE
To explore the attitudes, barriers, and behaviors of clinician educators (CEs) regarding advocating routine HIV testing to their trainees.


METHODS
We analyzed CE responses to a 2009 survey of Society of General Internal Medicine members from community, VA, and university-affiliated clinics regarding HIV testing practices.


METHODS
Clinician educators were asked about their outpatient practices, knowledge and attitudes regarding the revised CDC recommendations and whether they encouraged trainees to perform routine HIV testing. Associations between HIV testing knowledge and attitudes and encouraging trainees to perform routine HIV testing were estimated using bivariate and multivariable logistic regression.


RESULTS
Of 515 respondents, 367 (71.3%) indicated they supervised trainees in an outpatient general internal medicine clinic. These CEs demonstrated suboptimal knowledge of CDC guidelines and over a third reported continued risk-based testing. Among CEs, 196 (53.4%) reported that they encourage trainees to perform routine HIV testing. Higher knowledge scores (aOR 5.10 (2.16, 12.0)) and more positive attitudes toward testing (aOR 8.83 (4.21, 18.5)) were independently associated with encouraging trainees to screen for HIV. Reasons for not encouraging trainees to screen included perceived low local prevalence (37.2%), competing teaching priorities (34.6%), and a busy clinic environment (34.0%).


CONCLUSIONS
Clinician educators have a special role in the dissemination of the CDC recommendations as they impact the knowledge and attitudes of newly practicing physicians. Despite awareness of CDC recommendations, many CEs do not recommend universal HIV testing to trainees. Interventions that improve faculty knowledge of HIV testing recommendations and address barriers in resident clinics may enhance adoption of routine HIV testing.
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. gberken@jhmi.edu
Gail V
GV
Berkenblit
James M
JM
Sosman
Michael
M
Bass
Hirut T
HT
Gebrekristos
Joseph
J
Cofrancesco
Lynn E
LE
Sullivan
Robert L
RL
Cook
Marcia
M
Edison
Philip G
PG
Bashook
P Todd
PT
Korthuis
D015492:AIDS Serodiagnosis / Q000592:standards; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities / Q000592:standards; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004503:Education, Medical, Graduate / Q000592:standards*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007388:Internal Medicine / Q000193:education* / Q000592:standards; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D008403:Mass Screening / Q000523:psychology / Q000592:standards; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult