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Barriers to HIV Testing: Patient and Provider Perspectives in the Deep South

  • Jenni M. Wise
  • Corilyn Ott
  • Andres Azuero
  • Robin Gaines Lanzi
  • Susan Davies
  • Andrea Gardner
  • David E. Vance
  • Mirjam-Colette KempfEmail author
Original Paper
  • 101 Downloads

Abstract

Although CDC guidelines call for universal, “opt-out” HIV testing, barriers to testing continue to exist throughout the United States, with the rural South particularly vulnerable to both HIV infection and decreased awareness of status. Therefore, the objectives of this study were to evaluate uptake of “opt-out” HIV testing and barriers to testing within the primary care setting in the South. A concurrent triangulation design guided the collection of quantitative data from patients (N = 250) and qualitative data from providers (N = 10) across three primary health clinics in Alabama. We found that 30% of patients had never been tested for HIV, with the highest ranked barrier among patients being perceived costs, access to specialty care, and not feeling at risk. Significant differences existed in perceived barriers between patients and providers. Increased provider-patient engagement and the routine implementation of “opt-out” HIV testing would effectively reveal and mitigate barriers to testing, thus, increasing awareness of status.

Keywords

HIV Health knowledge, attitudes, practice Delivery of health care Screening Barriers 

Resumen

Aunque las pautas de la CDC recomiendan pruebas de VIH universales y de “exclusión voluntaria”, las barreras a dichas pruebas continúan existiendo en todo Estados Unidos, siendo el sur rural particularmente vulnerable a la infección por VIH y a un menor conocimiento de las condiciones vigentes. Por lo tanto, los objetivos de este estudio fueron evaluar la aceptación de las pruebas de VIH de “exclusión voluntaria” y las barreras que existen a dichas pruebas en el entorno de atención de la salud primaria en el sur. Un diseño de triangulación concurrente guio la recopilación de datos cuantitativos de pacientes (N = 250) y datos cualitativos de proveedores (N = 10) en tres clínicas de salud primaria en Alabama. Descubrimos que el 30% de los pacientes nunca habían sido evaluados para detectar el VIH, y que la barrera más alta entre los pacientes es la percepción de los costos, el acceso a la atención especializada y el no sentirse en riesgo. Existen diferencias significativas en la percepción de las barreras entre los pacientes y los proveedores. Tanto una mayor interacción entre proveedores y pacientes, así como la implementación rutinaria de las pruebas de VIH de “exclusión voluntaria” revelarían y mitigarían de manera efectiva las barreras a las pruebas, aumentando así el conocimiento de las condiciones vigentes.

Notes

Acknowledgements

This research was supported by the University of Alabama at Birmingham (UAB) Center For AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, NIDCR and OAR; and the National Institutes of Health (NIH), National Institute on Minority Health and Health Disparities (NIMHD), Gulf States Health Policy grant (U54MD008602).

Compliance with Ethical Standards

Conflict of interest

All authors included on this manuscript declare that he/she has no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Centers for Disease Control and Prevention. HIV in the United States: At a glance. 2017. https://www.cdc.gov/hiv/statistics/overview/ataglance.html.
  2. 2.
    Farnham PG, Gopalappa C, Sansom SL, Hutchison AB, Brooks JT, Weidle PJ, et al. Updates of lifetime costs of care and quality-of-life estimates for HIV-infected persons in the United States: late versus early diagnosis and entry into care. J Acquir Immune Defic Syndr. 2013;64(2):183–9.  https://doi.org/10.1097/qai.0b013e3182973966.CrossRefPubMedGoogle Scholar
  3. 3.
    Hall HI, Holtgrave DR, Tang T, Rhodes P. HIV transmission in the United States: Considerations of viral load, risk behavior, and health disparities. AIDS Behav. 2013;17(5):1632–6.  https://doi.org/10.1007/s10461-013-0426-z.CrossRefPubMedGoogle Scholar
  4. 4.
    Southern HIV/AIDS Strategy Initiative. 2016. SASI releases: HIV/AIDS in the US Deep South: Trends from 2008 to 2013. https://southernaidsstrategy.org/research/.
  5. 5.
    White BL, Walsh J, Rayasam S, Pathman DE, Adimora AA, Golin CE. 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. J Int Assoc Provid AIDS Care. 2015;14(2):127–35.  https://doi.org/10.1177/2325957414524025.CrossRefPubMedGoogle Scholar
  6. 6.
    Hudson AL, Heilemanna MV, Rodriguez M. Missed opportunities for universal HIV screening in primary care clinics. J Clin Med Res. 2012;4(4):242–50.  https://doi.org/10.4021/jocmr1014w.PubMedGoogle Scholar
  7. 7.
    Pellowski JA. Barriers to care for rural people living with HIV: a review of domestic research and health care models. J Assoc Nurses AIDS Care. 2013;24(5):422–37.  https://doi.org/10.1016/j.jana.2012.08.007.CrossRefPubMedGoogle Scholar
  8. 8.
    Sutton M, Anthony M, Vila C, McLellan-Lemal E, Weidle PJ. HIV testing and HIV/AIDS treatment services in rural counties in 10 southern states: service provider perspectives. J Rural Health. 2010;26:24–247.  https://doi.org/10.1111/j.1748-0361.2010.00284.x.CrossRefGoogle Scholar
  9. 9.
    Toth M, Messer L, Quinlivan EB. Barriers to HIV care for women of color living in the Southeastern US are associated with physical symptoms, social environment, and self-determination. AIDS Patient Care STDs. 2013;27(11):613–20.  https://doi.org/10.1089/apc.2013.0030.CrossRefPubMedGoogle Scholar
  10. 10.
    Centers for Disease Control and Prevention. CDC fact sheet: today’s HIV/AIDS epidemic [PDF]. 2016. https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/todaysepidemic-508.pdf.
  11. 11.
    Centers for Disease Control and Prevention. HIV in the Southern United States [PDF]. 2016. https://www.cdc.gov/hiv/pdf/policies/cdc-hiv-in-the-south-issue-brief.pdf.
  12. 12.
    Alabama Department of Public Health. Alabama 2012-2016 Statewide Jurisdictional HIV Prevention Plan [PDF]. n.d. http://www.adph.org/aids/assets/HIVplan2012-2016.pdf.
  13. 13.
    Centers for Disease Control and Prevention. Revised Guidelines for HIV Counseling, Testing, and Referral. 2001. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm.
  14. 14.
    Branson, BM, Handsfield, HH, Lampe, MA, Janssen, RS, Taylor, AW, Lyss, SB, Clark, J E. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings [PDF]. 2006. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm.
  15. 15.
    AIDSVu. Alabama. n.d. https://aidsvu.org/state/alabama/.
  16. 16.
    AIDSVu. Data methods-State/country. https://aidsvu.org/data-methods-statecounty/.
  17. 17.
    d’Almeida KG, Kierzek G, Truchis P, Le Vu S, Pateron D, Renaud B, et al. Modest public health impact of nontargeted human immunodeficiency virus screening in 29 emergency departments. Arch Intern Med. 2012;172(1):12–20.  https://doi.org/10.1001/archinternmed.2011.535.CrossRefPubMedGoogle Scholar
  18. 18.
    Health Resources and Services Administration (US). Bureau of Primary Health Care. What is a health center? n.d. http://bphc.hrsa.gov/about/what-is-a-health-center/index.html.
  19. 19.
    Pellowski JA, Kalichman SC, Matthews KA, Adler N. A pandemic of the poor: social disadvantage and the U.S. HIV epidemic. Am Psychol. 2013;68(4):197–209.  https://doi.org/10.1037/a0032694.CrossRefPubMedGoogle Scholar
  20. 20.
    Jason EF, Ana MK, Katrina R, et al. Development and evaluation of a pilot nurse case management model to address multidrug-resistant tuberculosis (MDR-TB) and HIV in South Africa. PLoS ONE. 2015;9(11):e111702.  https://doi.org/10.1371/journal.pone.0111702.Google Scholar
  21. 21.
    Jane LP, John XR, Patricia MD. Developing targeted health service interventions using the PRECEDE-PROCEED model: two Australian case studies. Nurs Res Pract. 2012.  https://doi.org/10.1155/2012/279431.Google Scholar
  22. 22.
    Cunningham N. An assessment of the HIV prevention needs of injection drug users in Montana. Ann Arbor: ProQuest Dissertations Publishing; 2007.Google Scholar
  23. 23.
    Hackney T. An HIV/AIDS intervention through churches in Mulanje District, Malawi. Carol Pap Int Dev. 2002;3:1–38.  https://doi.org/10.1080/13691058.2014.944569.Google Scholar
  24. 24.
    Hothorn THK, Zeileis A. Unbiased recursive partitioning: a conditional inference framework. J Comput Graph Stat. 2006;15(3):651–74.CrossRefGoogle Scholar
  25. 25.
    Bain L, Nkoke C, Noubiap J. UNAIDS 90–90–90 targets to end the AIDS epidemic by 2020 are not realistic: comment on “Can the UNAIDS 90–90–90 target be achieved? A systematic analysis of national HIV treatment cascades”. BMJ Glob Health. 2017;2(2):e000227.  https://doi.org/10.1136/bmjgh-2016-000227.CrossRefPubMedGoogle Scholar
  26. 26.
    Ebrahim SH, Anderson JE, Weidle P, Purcell DW. Race/ethnic disparities in HIV testing and knowledge about treatment for HIV/AIDS: United States, 2001. AIDS Patient Care STDS. 2004;18(1):27–33.CrossRefPubMedGoogle Scholar
  27. 27.
    Lo CC, Runnels RC, Cheng TC. Racial/ethnic differences in HIV testing: an application of the health services utilization model. Open Med. 2018.  https://doi.org/10.1177/2050312118783414.Google Scholar
  28. 28.
    Rosenstock IM. Historical origins of the health belief model. Health Educ Behav. 1974;2(4):328–35.  https://doi.org/10.1177/109019817400200403.Google Scholar
  29. 29.
    Gignon M, Idris H, Manaouil C, Ganry O. The waiting room: vector for health education? The general practitioner’s point of view. BMC Res Notes. 2012;5:511.  https://doi.org/10.1186/1756-0500-5-511.CrossRefPubMedGoogle Scholar
  30. 30.
    Centers for Disease Control and Prevention. NCHHSTP AtlasPlus. 2017. https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5019a1.htm.
  31. 31.
    Betancourt J, Green A, Carrillo J, Park E. Cultural competence and health care disparities: key perspectives and trends. Health Aff. 2005;24(2):499–505.  https://doi.org/10.1377/hlthaff.24.2.499.CrossRefGoogle Scholar
  32. 32.
    Marla BH, Jeffrey JG, Mckyer ELJ, Corliss O, Danny B. Continuing education effects on cultural competence knowledge and skills building among health professionals. Online J Health Allied Sci. 2013;12(2).Google Scholar
  33. 33.
    Batey DS, Whitfield S, Mulla M, et al. Adaptation and Implementation of an intervention to reduce HIV-related stigma among healthcare workers in the United States: piloting of the FRESH Workshop. AIDS Patient Care STDs. 2016;30(11):519–27.  https://doi.org/10.1089/apc.2016.0223.CrossRefPubMedGoogle Scholar
  34. 34.
    Larson KE, Bradhsaw CP. Cultural competence and social desirability among practitioners: a systematic review of the literature. Child Youth Serv Rev. 2017;76:100–11.  https://doi.org/10.1016/j.childyouth.2017.02.034.CrossRefGoogle Scholar
  35. 35.
    Edmunds JM, Beidas RS, Kendall PC. Dissemination and implementation of evidence-based practice: training and consultation as implementation strategies. Clin Psychol. 2013;20(2):152–65.  https://doi.org/10.1111/cpsp.12031.Google Scholar
  36. 36.
    Sanders GD, Anaya HD, Asch S, et al. Cost-effectiveness of strategies to improve HIV testing and receipt of results: economic analysis of a randomized controlled trial. J Gen Intern Med. 2010;25(6):556–63.  https://doi.org/10.1007/s11606-010-1265-5.CrossRefPubMedGoogle Scholar
  37. 37.
    Reif S, Pence BW, Hall I, Hu X, Whetten K, Wilson E. HIV diagnoses, prevalence and outcomes in nine southern states. J Communit Health. 2015;40(4):642–51.  https://doi.org/10.1007/s10900-014-9979-7.CrossRefGoogle Scholar
  38. 38.
    Godlonton S, Thornton RL. Learning from others’ HIV testing: updating beliefs and responding to risk. Am Econ Rev. 2013;103(3):439–44.CrossRefPubMedGoogle Scholar
  39. 39.
    Henkel KE, Brown K, Kalichman SC. AIDS-related stigma in individuals with other stigmatized identities in the USA: a review of layered stigmas. Soc Personal Psychol Compass. 2008;2(4):1586–99.  https://doi.org/10.1111/j.1751-9004.2008.00116.x.CrossRefGoogle Scholar
  40. 40.
    Kempf M-C, McLeod J, Boehme AK, et al. A qualitative study of the barriers and facilitators to retention-in-care among HIV-positive women in the rural southeastern United States: implications for targeted interventions. AIDS Patient Care STDs. 2010;24(8):515.  https://doi.org/10.1089/apc.2010.0065.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Jenni M. Wise
    • 1
  • Corilyn Ott
    • 1
    • 2
  • Andres Azuero
    • 1
  • Robin Gaines Lanzi
    • 3
  • Susan Davies
    • 3
  • Andrea Gardner
    • 5
  • David E. Vance
    • 1
  • Mirjam-Colette Kempf
    • 1
    • 2
    • 3
    • 4
    Email author
  1. 1.School of NursingUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Division of Infections Disease, School of MedicineUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.Department of Behavior Health, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  4. 4.Department of Epidemiology, School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  5. 5.School of NursingTroy UniversityTroyUSA

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