Provider and Practice Characteristics Associated with Use of Rapid HIV Testing by General Internists
Rapid HIV testing could increase routine HIV testing. Most previous studies of rapid testing were conducted in acute care settings, and few described the primary care providers’ perspective.
To identify characteristics of general internal medicine physicians with access to rapid HIV testing, and to determine whether such access is associated with differences in HIV-testing practices or perceived HIV-testing barriers.
Web-based cross-sectional survey conducted in 2009.
A total of 406 physician members of the Society of General Internal Medicine who supervise residents or provide care in outpatient settings.
Surveys assessed provider and practice characteristics, HIV-testing types, HIV-testing behavior, and potential barriers to HIV testing.
Among respondents, 15% had access to rapid HIV testing. In multivariable analysis, physicians were more likely to report access to rapid testing if they were non-white (OR 0.45, 95% CI 0.22, 0.91), had more years since completing training (OR 1.06, 95% CI 1.02, 1.10), practiced in the northeastern US (OR 2.35; 95% CI 1.28, 4.32), or their practice included a higher percentage of uninsured patients (OR 1.03; 95% CI 1.01, 1.04). Internists with access to rapid testing reported fewer barriers to HIV testing. More respondents with rapid than standard testing reported at least 25% of their patients received HIV testing (51% versus 35%, p = 0.02). However, access to rapid HIV testing was not significantly associated with the estimated proportion of patients receiving HIV testing within the previous 30 days (7.24% vs. 4.58%, p = 0.06).
Relatively few internists have access to rapid HIV testing in outpatient settings, with greater availability of rapid testing in community-based clinics and in the northeastern US. Future research may determine whether access to rapid testing in primary care settings will impact routinizing HIV testing.
KEY WORDSHIV testing rapid HIV testing HIV/AIDS general internal medicine physicians HIV prevention medical practice setting
We want to thank our colleagues at the Society for General Internal Medicine for responding to our survey, and providing thoughtful feedback. We appreciate the funding we received from the Centers for Disease Control and Prevention, and our respective agencies, which allowed us to carry on this work. We wish to especially thank Leslie Dunne, our SGIM project manager, who facilitated this effort to completion.
Sources of Support
This work was supported by a grant from the Centers for Disease Control (CDC grant number 1 U22 PS00551-02 HIV Prevention with National Medical Associations), in conjunction with the Society of General Internal Medicine, HIV/AIDS Task Force. Dr. Sullivan was supported by the Robert Wood Johnson Foundation Physician Faculty Scholars Program during the conduct of this work. Drs. Bashook and Edison were supported by a grant from the Health Resources Services Administration for the Midwest AIDS Education and Training Center during the conduct of this work. Dr. Korthuis was supported by the National Institutes of Health, National Institute on Drug Abuse (K23 DA019809) during the conduct of this work.
The contents of this publication are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies, the US government, or the Department of Veterans Affairs.
Conflict of Interest
- 1.Branson BM, Handsfield HH, Lampe MA, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations & Reports. 2006;55(RR-14):1–17.Google Scholar
- 4.Centers for Disease Control and Prevention. (2008) CDC: HIV Prevalence Estimates—United States, 2006. MMWR. 2008, 57(39), vol 55, 1073–6.Google Scholar
- 5.Qaseem A, Snow V, Shekelle P, et al. Clinical Efficacy Assessment Subcommittee; American College of Physicians. Screening for HIV in health care settings: A guidance statement from the American College of Physicians and HIV Medicine Association. Ann Intern Med. 2009;150(2):125–31.PubMedGoogle Scholar
- 6.Centers for Disease Control and Prevention. Advancing HIV prevention: New strategies for a changing epidemic—United States, 2003. MMWR. 2003;52(15):329–32.Google Scholar
- 15.Centers for Disease Control and Prevention. Rapid HIV testing in emergency departments—Three US sites, January 2005–March 2006. MMWR 2007; 56(24): 597–601.Google Scholar
- 18.Centers for Disease Control and Prevention. Routine Jail-Based HIV Testing-Rhode Island, 2000–2007. MMWR. 2010;59(24):742–5.Google Scholar
- 21.Bashook PG, Edison MI, Sullivan LE, et al. Physician barriers to implementing routine HIV testing in primary care settings: A qualitative analysis. J Gen Intern Med. 2008;23(Suppl 2):367.Google Scholar
- 22.Korthuis PT, Berkenblit GV, Sullivan LE, et al. General internists’ beliefs, behaviors, and perceived barriers to routine HIV screening in primary care. AIDS Educ Prev. 2011;23((3) Suppl):53–66.Google Scholar
- 27.Centers for Disease Control and Prevention. Trends in diagnoses of HIV infection-District of Columbian 2004—2008. MMWR. 2010; 59(24): 737–41.Google Scholar
- 28.Burnstein GR, Newman DR, San Antonio-Gaddy ML, et al. Client preference for quick Ora-Quick test results in 3 US states. International Conference on AIDS (15th): 2004; Bangkok, Thailand. Available at: http://gateway.nlm.nih.gov/MeetingAbstracts/ma?f=102279405.html Accessed April 29, 2011
- 32.Farnham PG, Hutchinson AB, Sansom L, et al. Comparing the costs of HIV screening strategies and technologies in health-care settings. Public Health Rep. 2008; Suppl 3: 51–62.Google Scholar
- 35.Institute of Medicine of the National Academies. HIV screening and access to care: Exploring barriers and facilitators to expanded HIV testing. Committee on HIV Screening and Access to Care; Board on Population Health and Public Health Practice. Washington, DC: The National Academies Press; 2010.Google Scholar
- 36.President of the United States. National HIV/AIDS strategy for the United States. 2010, July. Available at: http://www.whitehouse.gov/sites/default/files/uploads/NHAS.pdf Accessed April 28, 2011