title: What Makes Me Screen for HIV? Perceived Barriers and Facilitators to Conducting Recommended Routine HIV Testing among Primary Care Physicians in the Southeastern United States.
abstract: The Centers for Disease Control and Prevention have recommended routinely testing patients (aged 13-64) for HIV since 2006. However, many physicians do not routinely test. From January 2011 to March 2012, we conducted 18 in-depth individual interviews and explored primary care physicians' perceptions of barriers and facilitators to implementing routine HIV testing in North Carolina. Physicians' comments were categorized thematically and fell into 5 groups: policy, community, practice, physician, and patient. Lack of universal reimbursement was identified as the major policy barrier. Participants believed endorsement from the United States Preventive Services Tasks Force would facilitate adoption of routine HIV testing policies. Physicians reported HIV/AIDS stigma, socially conservative communities, lack of confidentiality, and rural geography as community barriers. Physicians believed public HIV testing campaigns would legitimize testing and decrease stigma in communities. Physicians cited time constraints and competing clinical priorities as physician barriers that could be overcome by delegating testing to nursing staff. HIV test refusal, low HIV risk perception, and stigma emerged as patient barriers. Physicians recommended adoption of routine HIV testing for all patients to facilitate and destigmatize testing. Physicians continue to experience a variety of barriers when implementing routine HIV testing in primary care settings. Our findings support multilevel approaches to enhance physician routine HIV testing in primary care settings.
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA bls@med.unc.edu.
authors.forename: Becky L
authors.initials: BL
authors.lastname: White
authors.affiliation: Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Joan
authors.initials: J
authors.lastname: Walsh
authors.affiliation: Duke Human Vaccine Institute, Duke University School of Medicine, Durham, NC, USA.
authors.forename: Swati
authors.initials: S
authors.lastname: Rayasam
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.affiliation: Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA Department of Health Behavior, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D003955:Diagnostic Tests, Routine / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D015144:Southeastern United States; D000078329:Workforce
keywords: HIV; barriers; physicians; screening; southeast