title: General practitioners' barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study.
abstract: European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UK guidelines recommend performing a 'routine offer of HIV testing' in primary care where HIV prevalence exceeds 2 in 1000. Implementation of new provider-initiated HIV testing strategies in general practice is limited, while the numbers of undiagnosed and late for care HIV patients remain high. We have explored Dutch general practitioners' barriers to and facilitators of both strategies. We combined semi-structured in-depth interviews with focus groups. Nine general practitioners - key informants of sexually transmitted infection/HIV prevention and control - were selected for the interviews. Additionally, we organised focus groups with a broad sample of general practitioners (n = 81). Framework analysis was used to analyse the data. Various barriers were found, related to (1) the content of the guidelines (testing the right group and competing priorities in general practice), (2) their organisational implementation (lack of time, unclear when to repeat the HIV test and overlong list of ICs) and (3) the patient population (creating fear among patients, stigmatising them and fear regarding financial costs). Multiple general practitioners stated that performing a sexual risk assessment of patients is important before applying either strategy. Also, they recommended implementing the IC-guided approach only in high-prevalence areas and combining HIV tests with other laboratory blood tests. General practitioners tend to cling to old patterns of risk-based testing. Promoting awareness of HIV testing and educating general practitioners about the benefits of new provider-initiated HIV testing strategies is important for the actual uptake of HIV testing.
authors.affiliation: 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Ivo K
authors.initials: IK
authors.lastname: Joore
authors.affiliation: 2 Amsterdam Institute for Global Health and Development (AIGHD), Amsterdam, The Netherlands.
authors.forename: Sanne Lc
authors.initials: SL
authors.lastname: van Roosmalen
authors.affiliation: 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.|3 STI AIDS Netherlands (Soa Aids Nederland), Amsterdam, Netherlands.|4 Epidemiology & Surveillance Unit, Centre for Infectious Disease Control, National Institute of Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
authors.forename: Jan Eam
authors.initials: JE
authors.lastname: van Bergen
authors.affiliation: 1 Department of General Practice/Family Medicine, Division of Clinical Methods and Public Health, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Nynke
authors.initials: N
authors.lastname: van Dijk
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D017144:Focus Groups; D058006:General Practice; D058005:General Practitioners; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control
keywords: HIV; Qualitative research; epidemiology; general practice; guidelines; primary health care