title: Scaling up routine HIV testing at specialty clinics: assessing the effectiveness of an academic detailing approach.
abstract: BACKGROUND
  Scaling up routine HIV testing represents a key component of the National HIV/AIDS Strategy. Barriers to routine HIV testing have limited widespread adoption. Although many patients visit specialty care providers, few efforts to increase routine HIV testing in specialty care settings have been made. We report on use of a survey of barriers to routine testing coupled with academic detailing-type educational sessions to increase routine testing at specialty clinics in Chicago's main safety-net health system.
  
  
  METHODS
  We devised a survey to assess specialty provider knowledge, attitudes, and barriers to routine HIV testing. We administered this at 3 specialty clinics. Each clinic's survey responses informed content for academic detailing-type presentations to each clinic's medical providers. We provide descriptive statistics summarizing survey responses. We report changes in the HIV testing rates and use logistic regression to examine associations between time period and odds of testing at each clinic.
  
  
  RESULTS
  Specialty clinic providers demonstrated varying knowledge regarding routine HIV testing guidelines-with trauma providers having the least knowledge. Concerns regarding arranging follow-up for patients with positive results was the most cited barrier to testing. Two of the 3 specialty clinics experienced significant increases in routine HIV testing, whereas the third specialty service, which uses more rotating residents, had downtrending routine testing rates.
  
  
  CONCLUSIONS
  The increase in routine HIV testing in 2 of 3 specialty services suggests that academic detailing-type interventions can improve routine testing uptake in public safety-net specialty care settings and may represent a useful component to incorporate into system-wide scale-up efforts.
authors.affiliation: *Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL; †Department of Medicine, Rush University Medical Center, Chicago, IL; ‡Chicago Developmental Center for AIDS Research (D-CFAR), Chicago, IL; §Chicago Consortium, Women's Interagency HIV Study; ‖Department of Prevention and Education, Ruth M. Rothstein CORE Center, Chicago, IL; and ¶STI/HIV Services Division, Chicago Department of Public Health.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Lubelchek
authors.forename: Anna L
authors.initials: AL
authors.lastname: Hotton
authors.forename: Daniel
authors.initials: D
authors.lastname: Taussig
authors.forename: David
authors.initials: D
authors.lastname: Amarathithada
authors.forename: Marisol
authors.initials: M
authors.lastname: Gonzalez
mesh_terms: D015492:AIDS Serodiagnosis / Q000379:methods / Q000706:statistics & numerical data*; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D001291:Attitude of Health Personnel; D002641:Chicago; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008297:Male; D008403:Mass Screening; D017410:Practice Guidelines as Topic