Did You Know?
Forty-five percent of providers practicing within communities of color perceive having inadequate training to offer HIV testing to their patients. (1)
Issue: In response to getting people into early HIV care, the Centers for Disease Control and Prevention (CDC) recommended routine testing in all US medical settings, in 2006.(2) Existing literature suggests that patients are now largely accepting of HIV testing.(3) However, much of the failure to expand testing appears to stem from healthcare providers’ hesitancy to routinely administer the test to their patients. Given the integral role of the clinician in the overall culture of a health care setting, such behaviors may unduly influence the rate of testing within these environments. For this reason, identifying factors that inhibit providers from routinely offering HIV testing is critical to the successful implementation of the new recommendations. Addressing these inhibitions in an appropriate and effective manner should help HIV providers promote and increase HIV testing and diagnosis services.
Description: The National Minority AIDS Education and Training Center (NMAETC), located in the College of Medicine at Howard University, Department of Infectious Diseases assessed providers’ perspectives, practices and attitudes related to HIV testing.(1) This included their familiarity with current CDC recommendations and the feasibility of testing in their respective healthcare settings. Participants were selected using convenience sampling.
Lessons learned: NMAETC data1 reveals that 36% of HIV care providers reported that they “do not have adequate training” to perform HIV testing. Of those offering a HIV test, 45% reported that a lack of training influenced their decision to offer a test. Fifty-one percent of this same group also report that they do not offer HIV testing at all. These findings are consistent with the results of a systematic review conducted by Burke, Sepkowitz, Bernstein, et al in 2007.(4) They also found a lack of adequate knowledge and training across multiple practice settings.4 The prevalence of inadequate knowledge about HIV testing jeopardizes the health of the very community in which the disease burden is stubbornly familiar and further adds toe HIV disparity.
Next steps: The effects of barriers, such as inadequate training, may be mitigated through continuing education and training. NMAETC is dedicated to increasing the capacity of organizations to diagnose and provide culturally competent clinical care to individuals at-risk for or who are living with HIV/AIDS. Additionally, the evidence-based training provided by NMAETC and its affiliates is based upon provider-driven programs, training and support designed to foster preventive behavior and improve clinical outcomes. Our commitment to this mission is to promote organizations and providers that are confident and fully prepared to deliver quality care to racial and ethnic minority populations.
(1) Downer, G., McKinney, S., Watson, K. (2008). Provider Perspectives and Practices on HIV Testing, National Minority AIDS Education and Training Center (NMAETC), Howard University College of Medicine, Department of Infectious Diseases, Washington, DC.
(2)Centers for Disease Control and Prevention. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR RecommRep 2006; 55:1–17
(3)Irwin KL, Valdiserri RO, Holmberg SD. The acceptability of voluntary HIV antibody testing in the United States: a decade of lessons learned. AIDS 1996; 10:1707–1717.
(4)Burke RC, Sepkowitz KA, Bernstein KT, Karpati AM, Myers JE, Tsoi BW, and Begier EM. (2007) Why Don't Physicians Test for HIV? A Review of the US Literature. AIDS: 21:12(1617-1624).