Bokhour BG (Center for Health Quality, Outcomes and Economic Research (CHQOER), HIV/HEP QUERI), Solomon JL
(CHQOER, HIV/HEP QUERI), Knapp H
(HIV/HEP QUERI), Asch SM
(HIV/HEP QUERI), Gifford AL
(CHQOER, HIV/HEP QUERI)
In 2006, the CDC released new recommendations that all adults should be offered HIV testing routinely, regardless of risk behaviors. In the VA, even among those with risk behaviors, less than 1/3 of veterans in care have ever been HIV-tested. Therefore, improving HIV testing rates is an important VA clinical priority. We sought to evaluate barriers and facilitators to routine HIV testing from the perspectives of patients and primary care providers.
We conducted two focus groups with primary care patients, and one focus group with providers, at each of two VA primary care clinics. Focus groups used a semi-structured guide to inquire about participant experiences with HIV testing, barriers to HIV testing, communicating about HIV during appointments, and the utility of VA- and CDC-generated educational materials to encourage routine HIV testing. Data were analyzed using established qualitative methods.
Both patients and providers identified the current need to obtain specific, signed informed consent for the HIV blood test as a substantial barrier. Patients and providers expressed a desire to integrate HIV testing into routine blood work, as is done for other chronic diseases. Patients indicated that although testing should be routine, as one noted, “it shouldn’t be automatic.” Others expressed concern about the confidentiality of HIV results. Although a major barrier for providers was having adequate time in the clinical encounter to address patient concerns about HIV testing, veteran patients indicated that extensive discussion was unnecessary prior to testing. Educational materials were viewed as informative and helpful in influencing patients to be tested.
Barriers to routine testing included the use of consent forms, concerns about privacy, and time for adequate discussion. Communication about HIV testing should be streamlined while still allowing patients to make an informed choice about whether to be tested. Describing HIV as a treatable chronic disease may promote testing.
Finding ways for providers to offer testing as part of routine care is critical to improving rates of HIV detection. Offering brochures about routine HIV testing prior to appointments will facilitate conversations and improve HIV testing rates. The data suggest that VA should consider streamlining the written informed consent process.