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Hamdan S, Smyth E, Murphy ME, Grussing ED, Wei M, Guardado R, Wurcel A. Racial and Ethnic Disparities in HIV Testing in People Who Use Drugs Admitted to a Tertiary Care Hospital. AIDS Patient Care STDS 2022; 36:425-430. [PMID: 36301195 PMCID: PMC9700355 DOI: 10.1089/apc.2022.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Ending the HIV epidemic requires increased testing, diagnosis, and linkage to care. In the past 10 years, rates of HIV have increased among people with substance use disorder (SUD). HIV testing is recommended during hospitalization. Despite rising rates of infections and recommendations, HIV testing remains suboptimal. This study sought to detect differences in HIV testing by race and ethnicity in people who use drugs (PWUD) admitted to Tufts Medical Center (TuftsMC). This study is a retrospective review of hospitalized PWUD admitted from January 1, 2017 to December 31, 2020. PWUD were identified through toxicology results, medication prescribed for SUD, and nursing intake questions. The primary outcome of interest was whether an HIV test was ordered during hospitalization. The indicator of interest was race and ethnicity. Of 13,486 PWUD admitted to TuftsMC, only 10% had an HIV test ordered. Compared with White patients, Black patients [adjusted odds ratio (AOR): 0.69, 95% confidence interval (CI) (0.59-0.83)] and Hispanic patients [AOR: 0.68, 95% CI (0.55-0.84)] had decreased odds of receiving an HIV test. Our report is the first to show racial and ethnic differences in HIV testing ordering for hospitalized PWUD. Without access to harm reduction tools and expanded systems-based testing strategies, the HIV epidemic will continue and disproportionately impact minoritized communities.
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Affiliation(s)
- Sami Hamdan
- Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Emma Smyth
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | | | | | - Mingrui Wei
- Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Rubeen Guardado
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Alysse Wurcel
- Division of Geographic Medicine and Infectious Diseases, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
- Tufts University School of Medicine, Boston, Massachusetts, USA
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Wang W, Shi X, Jiang Y, Zhao H, Ong JJ, Wu D, Tucker JD, Terris-Prestholt F, Pan SW. Fear of nosocomial HIV infection may be a barrier to HIV testing among young college and university students in Suzhou, China. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:1154-1160. [PMID: 32672506 DOI: 10.1080/07448481.2020.1786099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/13/2020] [Accepted: 06/12/2020] [Indexed: 06/11/2023]
Abstract
ObjectiveHuman immunodeficiency virus (HIV) test uptake among college and university students in China remains suboptimal. This study aimed to identify and weigh the relative importance of HIV testing preferences among university students in China. Participants and methods: Qualitative interviews and discrete choice experiments (DCE) were used to identify and assess HIV testing preferences in hypothetical HIV testing scenarios. Study participants were sexually experienced university students in Suzhou city, China. Results: 198 participants completed 1980 DCE choice tasks. Risk of nosocomial HIV infection, accuracy, and distance were identified as the most important factors when deciding whether to test for HIV. Risk of nosocomial HIV infection was the most influential factor, accounting for 35.5% of the variation in participants' DCE stated choices. Conclusions: Fear of HIV nosocomial infection may be influencing HIV test preferences and possibly test uptake among university students in China. Interventions should consider addressing students' fear of HIV nosocomial infection as a potential barrier to HIV testing.
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Affiliation(s)
- Wanqi Wang
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Xiao Shi
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Yifan Jiang
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Hanrui Zhao
- Department of Biological Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
| | - Jason J Ong
- Central Clinical School, Monash University, Clayton, VIC, Australia
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Dan Wu
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
| | - Joseph D Tucker
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK
- School of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Stephen W Pan
- Department of Health and Environmental Sciences, Xi'an Jiaotong-Liverpool University, Suzhou, China
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Luu MN, Wada PY, Levine-Hall T, Hurley L, Ramalingam N, Tran HN, Slome SB. Using a report card to increase HIV screening in a large primary care group practice. BMJ Open Qual 2021; 10:bmjoq-2020-000988. [PMID: 33414253 PMCID: PMC7797258 DOI: 10.1136/bmjoq-2020-000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 12/08/2020] [Accepted: 12/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background Despite increased efforts to promote HIV screening, a large proportion of the US population have never been tested for HIV. Objective To determine whether provider education and personalised HIV screening report cards can increase HIV screening rates within a large integrated healthcare system. Design This quality improvement study provided a cohort of primary care physicians (PCPs) a brief educational intervention and personalised HIV screening report cards with quarterly performance data. Participants Participants included a volunteer cohort of 20 PCPs in the department of adult and family medicine. Main measures Per cent of empaneled patients screened for HIV by cohort PCPs compared with PCPs at the Kaiser Permanente Oakland Medical Center (KPOAK) and the non-Oakland Medical Centers in Northern California region (Kaiser Permanente Northern California (KPNC)). Key results Of the 20 participating PCPs, 13 were female and 7 were male. Thirteen were internal medicine and seven family medicine physicians. The average age was 40 years and average practice experience was 9 years after residency. During the 12-month intervention, the estimated increase in HIV screening in the cohort PCP group was 2.6% as compared with 1.9% for KPOAK and 1.8% for KPNC. Conclusions These findings suggest that performance-related report cards are associated with modestly increased rates of HIV screening by PCPs.
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Affiliation(s)
- Mitchell N Luu
- Adult and Family Medicine, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Paul Y Wada
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Tory Levine-Hall
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Leo Hurley
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA
| | - Nirmala Ramalingam
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - H Nicole Tran
- Graduate Medical Education, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
| | - Sally B Slome
- Infectious Diseases, Kaiser Permanente Oakland Medical Center, Oakland, California, USA
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Magnus M, Edwards E, Dright A, Gilliam L, Brown A, Levy M, Sikka N, Siegel M, Criss V, Watson CC, Machtinger E, Kuo I. Development of a telehealth intervention to promote care-seeking among transgender women of color in Washington, DC. Public Health Nurs 2020; 37:262-271. [PMID: 32017202 DOI: 10.1111/phn.12709] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 11/21/2019] [Accepted: 01/05/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transgender women of color (TWC) are an underserved population who often experience high rates of HIV and barriers to care including stigma, violence, and trauma. Few health information technology interventions are tailored to serve TWC. The purpose of this study was to inform the development of a TWC-specific telehealth intervention to increase access to care. METHODS Formative qualitative semi-structured interviews and focus groups were conducted to develop a customized telehealth intervention for TWC. Participants were TWC ≥ 18 years living in the Washington, DC metropolitan area, with at least one structural barrier to care and clinicians ≥18 years who provide care to TWC. Transcripts were analyzed using thematic coding and content analysis; barriers for TWC were categorized into Individual, Organizational, and Environmental levels. Several day-long meetings with TWC and stakeholders were convened to develop the intervention. RESULTS Saturation of theme on barriers to care was reached with 22 interviews. Identified barriers to service receipt included survival, instability, temporal discounting, and prioritizing hormone therapy over care, incongruence between providers and patients, pessimism, and lack of cultural competency. Each was intentionally addressed with the telehealth intervention. CONCLUSIONS Data informed the development of an innovative and customized telehealth intervention for TWC. Through the integration of technology and peer consultant outreach, we developed a novel approach that can address population-specific challenges to care. Further development of this model may be able to improve health outcomes among TWC.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Elizabeth Edwards
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Aurnell Dright
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Leandrea Gilliam
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Angela Brown
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Matthew Levy
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Neal Sikka
- Section of Innovative Practice, Department of Emergency Medicine, George Washington University, Washington, DC, USA
| | - Marc Siegel
- Medical Faculty Associates, Inc, George Washington University, Washington, DC, USA
| | - Vittoria Criss
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Christopher Chauncey Watson
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | - Edwards Machtinger
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Irene Kuo
- Department of Epidemiology, Milken Institute School of Public Health, George Washington University, Washington, DC, USA
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James AJ, Marable D, Cubbison CV, Tarbox AA, Mejia DL, Oo SA, Freedberg KA, Levison JH. HIV testing in a large community health center serving a multi-cultural patient population: A qualitative study of providers. AIDS Care 2019; 31:1585-1592. [PMID: 31131623 DOI: 10.1080/09540121.2019.1612016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In the United States, 15% of HIV-positive individuals do not know their HIV serostatus. While CDC guidelines recommend HIV testing for individuals age 13-64 years, racial and ethnic minorities continue to experience delays in HIV diagnosis. We assessed providers' perspectives on HIV testing at an urban community health center serving racial/ethnic minority populations of low socioeconomic status. We conducted five focus groups from January 2017 to November 2017 with 74 health center staff: 20 adult medicine/primary care providers, 34 community health workers (CHWs) and community health administrators, six urgent care physicians, and fourteen behavioral health providers. Study staff analyzed transcripts using a grounded theory approach and used open coding to develop themes. We identified five themes affecting HIV testing: 1) provider perception of patients' preferences for HIV testing; 2) competing medical and social issues; 3) inter-professional communication; 4) knowledge of clinical indicators for HIV testing; and 5) knowledge of frequency of HIV testing. Primary care physicians desired mechanisms to easily identify patients for HIV testing and assistance with testing for non-English speakers. Training to improve comfort with HIV testing, integrating CHWs into routine practice, and focusing on patients' cultural beliefs may increase HIV testing in diverse community health centers..
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Affiliation(s)
- Anthony J James
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Danelle Marable
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Caroline V Cubbison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Andrew A Tarbox
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Dianna L Mejia
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA
| | - Sarah A Oo
- Center for Community Health Improvement, Massachusetts General Hospital , Boston , MA , USA
| | - Kenneth A Freedberg
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Infectious Diseases, Massachusetts General Hospital , Boston , MA , USA.,The Medical Practice Evaluation Center, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
| | - Julie H Levison
- From the Divisions of General Internal Medicine, Massachusetts General Hospital , Boston , MA , USA.,Harvard Medical School , Boston , MA , USA
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Branson BM, Chavez PR, Hanscom B, Greene E, McKinstry L, Buchacz K, Beauchamp G, Gamble T, Zingman BS, Telzak E, Naab T, Fitzpatrick L, El-Sadr WM. Expanding Hospital Human Immunodeficiency Virus Testing in the Bronx, New York and Washington, District of Columbia: Results From the HPTN 065 Study. Clin Infect Dis 2018; 66:1581-1587. [PMID: 29186421 PMCID: PMC5930256 DOI: 10.1093/cid/cix1053] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/23/2017] [Indexed: 01/20/2023] Open
Abstract
Background Human immunodeficiency virus (HIV) testing is critical for both HIV treatment and prevention. Expanding testing in hospital settings can identify undiagnosed HIV infections. Methods To evaluate the feasibility of universally offering HIV testing during emergency department (ED) visits and inpatient admissions, 9 hospitals in the Bronx, New York and 7 in Washington, District of Columbia (DC) undertook efforts to offer HIV testing routinely. Outcomes included the percentage of encounters with an HIV test, the change from year 1 to year 3, and the percentages of tests that were HIV-positive and new diagnoses. Results From 1 February 2011 to 31 January 2014, HIV tests were conducted during 6.5% of 1621016 ED visits and 13.0% of 361745 inpatient admissions in Bronx hospitals and 13.8% of 729172 ED visits and 22.0% of 150655 inpatient admissions in DC. From year 1 to year 3, testing was stable in the Bronx (ED visits: 6.6% to 6.9%; inpatient admissions: 13.0% to 13.6%), but increased in DC (ED visits: 11.9% to 15.8%; inpatient admissions: 19.0% to 23.9%). In the Bronx, 0.4% (408) of ED HIV tests were positive and 0.3% (277) were new diagnoses; 1.8% (828) of inpatient tests were positive and 0.5% (244) were new diagnoses. In DC, 0.6% (618) of ED tests were positive and 0.4% (404) were new diagnoses; 4.9% (1349) of inpatient tests were positive and 0.7% (189) were new diagnoses. Conclusions Hospitals consistently identified previously undiagnosed HIV infections, but universal offer of HIV testing proved elusive.
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Affiliation(s)
- Bernard M Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pollyanna R Chavez
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brett Hanscom
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Elizabeth Greene
- Leadership and Operations Center, HIV Prevention Trials Network, FHI, Durham, North Carolina
| | - Laura McKinstry
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Kate Buchacz
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Geetha Beauchamp
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Theresa Gamble
- Statistical Center for HIV/AIDS Research and Prevention, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Barry S Zingman
- Montefiore Medical Center and Albert Einstein College of Medicine, Bronx
| | | | - Tammey Naab
- Howard University Hospital, Washington, District of Columbia
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Pichiule-Castañeda M, Domínguez-Berjón MF, Esteban-Vasallo MD, García-Riolobos C, Álvarez-Castillo MC, Astray-Mochales J. Request for HIV serology in primary care: A survey of medical and nursing professionals. ENFERMERIA CLINICA 2018; 29:239-244. [PMID: 29343423 DOI: 10.1016/j.enfcli.2017.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/18/2017] [Accepted: 10/29/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION In the Community of Madrid there is 42.7% late HIV diagnosis. Primary care is the gateway to the health system and the frequency of serological tests requested by these professionals is unknown. The objectives were to establish the frequency of requests for HIV serology by medical and nursing primary care professionals in the Community of Madrid and the factors associated with these requests. METHOD An 'on-line' survey was conducted, asking professionals who participated in the evaluation study of strategies to promote early diagnosis of HIV in primary care in the Community of Madrid (ESTVIH) about the number of HIV-serology tests requested in the last 12 months. The association between HIV-serology requesting and the sociodemographic and clinical practice characteristics of the professionals was quantified using adjusted odds ratios (aOR) according to logistic regression. RESULTS 264 surveys (59.5% physicians). Eighty-two point two percent of medical and 18.7% of nursing professionals reported requesting at least one HIV-serology in the last 12 months (median: 15 and 2 HIV-serology request, respectively). The doctors associated the request with: being male (aOR: 2.95; 95% CI: 0.82-10.56), being trained in pre-post HIV test counselling (aOR: 2.42; 95% CI: 0.84-6.93) and the nurses with: age (<50 years; aOR: 2.75; 95% CI: 0.97-7.75), and number of years working in primary care (>13 years; aOR: 3.02; 95% CI: 1.07-8.52). CONCLUSION It is necessary to promote HIV testing and training in pre-post HIV test counselling for medical and nursing professionals in primary care centres.
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Affiliation(s)
| | | | - María D Esteban-Vasallo
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | - Carmen García-Riolobos
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
| | | | - Jenaro Astray-Mochales
- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
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- Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, España
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Levy I, Maor Y, Mahroum N, Olmer L, Wieder A, Litchevski V, Mor O, Rahav G. Missed opportunities for earlier diagnosis of HIV in patients who presented with advanced HIV disease: a retrospective cohort study. BMJ Open 2016; 6:e012721. [PMID: 28186940 PMCID: PMC5129188 DOI: 10.1136/bmjopen-2016-012721] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To quantify and characterise missed opportunities for earlier HIV diagnosis in patients diagnosed with advanced HIV. DESIGN A retrospective observational cohort study. SETTING A central tertiary medical centre in Israel. MEASURES The proportion of patients with advanced HIV, the proportion of missed opportunities to diagnose them earlier, and the rate of clinical indicator diseases (CIDs) in those patients. RESULTS Between 2010 and 2015, 356 patients were diagnosed with HIV, 118 (33.4%) were diagnosed late, 57 (16%) with advanced HIV disease. Old age (OR=1.45 (95% CI 1.16 to 1.74)) and being heterosexual (OR=2.65 (95% CI 1.21 to 5.78)) were significant risk factors for being diagnosed late. All patients with advanced disease had at least one CID that did not lead to an HIV test in the 5 years prior to AIDS diagnosis. The median time between CID and AIDS diagnosis was 24 months (IQR 10-30). 60% of CIDs were missed by a general practitioner and 40% by a specialist. CONCLUSIONS Missed opportunities to early diagnosis of HIV occur in primary and secondary care. Lack of national guidelines, lack of knowledge regarding CIDs and communication barriers with patients may contribute to a late diagnosis of HIV.
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Affiliation(s)
- Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Yasmin Maor
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
- Infectious Disease Unit, Wolfson Medical Center, Holon, Israel
| | - Naim Mahroum
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
| | - Liraz Olmer
- Unit of Biostatistics, Gertner Institute for Epidemiology and Health Policy Research, Tel Hashomer, Israel
| | - Anat Wieder
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
| | | | - Orna Mor
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
- Central Virology Laboratory, Ministry of Health, National HIV Reference Laboratory, Tel Hashomer, Israel
| | - Galia Rahav
- Infectious Disease Unit, Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Sackler School of Medicine, Tel Aviv, Israel
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Coyle C, Kwakwa H. Dual-Routine HCV/HIV Testing: Seroprevalence and Linkage to Care in Four Community Health Centers in Philadelphia, Pennsylvania. Public Health Rep 2016; 131 Suppl 1:41-52. [PMID: 26862229 DOI: 10.1177/00333549161310s106] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE Despite common risk factors, screening for hepatitis C virus (HCV) and HIV at the same time as part of routine medical care (dual-routine HCV/HIV testing) is not commonly implemented in the United States. This study examined improvements in feasibility of implementation, screening increase, and linkage to care when a dual-routine HCV/HIV testing model was integrated into routine primary care. METHODS National Nursing Centers Consortium implemented a dual-routine HCV/HIV testing model at four community health centers in Philadelphia, Pennsylvania, on September 1, 2013. Routine HCV and opt-out HIV testing replaced the routine HCV and opt-in HIV testing model through medical assistant-led, laboratory-based testing and electronic medical record modification to prompt, track, report, and facilitate reimbursement for tests performed on uninsured individuals. This study examined testing, seropositivity, and linkage-to-care comparison data for the nine months before (December 1, 2012-August 31, 2013) and after (September 1, 2013-May 31, 2014) implementation of the dual-routine HCV/HIV testing model. RESULTS A total of 1,526 HCV and 1,731 HIV tests were performed before, and 1,888 HCV and 3,890 HIV tests were performed after dual-routine testing implementation, resulting in a 23.7% increase in HCV tests and a 124.7% increase in HIV tests. A total of 70 currently HCV-infected and four new HIV-seropositive patients vs. 101 HCV-infected and 13 new HIV-seropositive patients were identified during these two periods, representing increases of 44.3% for HCV antibody-positive and RNA-positive tests and 225.0% for HIV-positive tests. Linkage to care increased from 27 currently infected HCV--positive and one HIV-positive patient pre-dual-routine testing to 39 HCV--positive and nine HIV-positive patients post-dual-routine testing. CONCLUSION The dual-routine HCV/HIV testing model shows that integrating dual-routine testing in a primary care setting is possible and leads to increased HCV and HIV screening, enhanced seropositivity diagnosis, and improved linkage to care.
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Affiliation(s)
- Catelyn Coyle
- National Nursing Centers Consortium, Philadelphia, PA
| | - Helena Kwakwa
- Philadelphia Department of Public Health, Clinical HIV Services, Philadelphia, PA
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Mayer KH, Crawford P, Dant L, Gillespie S, Singal R, Vandermeer M, Muench J, Long T, Quach T, Chaudhry A, Crane HM, Lembo D, Mills R, McBurnie MA. HIV and Hepatitis C Virus Screening Practices in a Geographically Diverse Sample of American Community Health Centers. AIDS Patient Care STDS 2016; 30:237-46. [PMID: 27286294 DOI: 10.1089/apc.2015.0314] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Because of the advent of highly effective treatments, routine screening for HIV and hepatitis C virus (HCV) has been recommended for many Americans. This study explored the perceived barriers surrounding routine HIV and HCV screening in a diverse sample of community health centers (CHCs). The Community Health Applied Research Network (CHARN) is a collaboration of CHCs, with a shared clinical database. In July, 2013, 195 CHARN providers working in 12 CHCs completed a survey of their attitudes and beliefs about HIV and HCV testing. Summary statistics were generated to describe the prevalence of HIV and HCV and associated demographics by CHCs. HIV and HCV prevalence ranged from 0.1% to 5.7% for HIV and from 0.1% to 3.7% for HCV in the different CHCs. About 15% of the providers cared for at least 50 individuals with HIV and the same was true for HCV. Two-thirds saw less than 10 patients with HIV and less than half saw less than 10 patients with HCV. Less than two-thirds followed USPHS guidelines to screen all patients for HIV between the ages of 13 and 64, and only 44.4% followed the guidance to screen all baby boomers for HCV. Providers with less HIV experience tended to be more concerned about routine screening practices. More experienced providers were more likely to perceive lack of time being an impediment to routine screening. Many US CHC providers do not routinely screen their patients for HIV and HCV. Although additional education about the rationale for routine screening may be indicated, incentives to compensate providers for the additional time they anticipate spending in counseling may also facilitate increased screening rates.
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Affiliation(s)
- Kenneth H. Mayer
- Fenway Health, Harvard Medical School, Beth Israel Deaconess, Boston, Massachusetts
| | - Phil Crawford
- Kaiser Permanente, Center for Health Research, Portland, Oregon
| | - Lydia Dant
- Fenway Health, Harvard Medical School, Beth Israel Deaconess, Boston, Massachusetts
| | | | - Robbie Singal
- Fenway Health, Harvard Medical School, Beth Israel Deaconess, Boston, Massachusetts
| | | | - John Muench
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
| | - Tim Long
- Near Northwest Services Organization, Alliance of Chicago, Chicago, Illinois
| | - Thu Quach
- Community Health and Research, Asian Health Services, Oakland, California
| | | | - Heidi M. Crane
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington
| | - Daniela Lembo
- Beaufort Jasper Hampton Comprehensive Health Services, Ridgeland, South Carolina
| | - Robert Mills
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland
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Traversy GP, Austin T, Ha S, Timmerman K, Gale-Rowe M. An overview of recent evidence on barriers and facilitators to HIV testing. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2015; 41:302-321. [PMID: 29769925 PMCID: PMC5864316 DOI: 10.14745/ccdr.v41i12a02] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND To address the issue of undiagnosed HIV infections, the Public Health Agency of Canada released the Human Immunodeficiency Virus-HIV Screening and Testing Guide in 2012, which identified several barriers and facilitators for HIV testing. OBJECTIVE The objective of this overview is to summarize the most recent evidence regarding barriers and facilitators to HIV testing, to expand upon the research conducted for the HIV Screening and Testing Guide. METHODS A review of the literature published between 2010 and 2014 was conducted using Scopus, PubMed (MEDLINE), and the Cochrane Library; websites of groups such as the Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control, Australian Department of Health, and New Zealand Ministry of Health were searched for recent reports. Studies were categorized based on the barrier or facilitator identified, and the results were summarized. RESULTS In addition to the known barriers of lack of perceived risk, lack of comfort or knowledge, provider time constraints, and fear of the diagnosis, stigma and discrimination, new studies have identified additional barriers including: fear regarding disclosure or lack of confidentiality, lack of access, lack of compensation of providers, and lack of human resources to carry out testing. In addition to the known facilitators of increased awareness and normalization of HIV screening and testing, opt-out testing was identified as a facilitator in recent studies. CONCLUSION Since 2010, research has advanced our knowledge of barriers and facilitators and can be applied to help decrease the number of undiagnosed HIV infections.
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Affiliation(s)
- GP Traversy
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - T Austin
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - S Ha
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - K Timmerman
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - M Gale-Rowe
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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Leidel S, McConigley R, Boldy D, Wilson S, Girdler S. Australian health care providers' views on opt-out HIV testing. BMC Public Health 2015; 15:888. [PMID: 26369954 PMCID: PMC4570459 DOI: 10.1186/s12889-015-2229-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 09/04/2015] [Indexed: 12/03/2022] Open
Abstract
Background Opt-out HIV testing is a novel concept in Australia. In the opt-out approach, health care providers (HCPs) routinely test patients for HIV unless they explicitly decline or defer. Opt-out HIV testing is only performed with the patients’ consent, but pre-test counselling is abbreviated. Australian national testing guidelines do not currently recommend opt-out HIV testing for the general population. Non-traditional approaches to HIV testing (such as opt-out) could identify HIV infections and facilitate earlier treatment, which is particularly important now that HIV is a chronic, manageable disease. Our aim was to explore HCPs’ attitudes toward opt-out HIV testing in an Australian context, to further understanding of its acceptability and feasibility. Methods In this qualitative study, we used purposeful sampling to recruit HCPs who were likely to have experience with HIV testing in Western Australia. We interviewed them using a semi-structured guide and used content analysis as per Graneheim to code the data. Codes were then merged into subcategories and finally themes that unified the underlying concepts. We refined these themes through discussion among the research team. Results Twenty four HCPs participated. Eleven participants had a questioning attitude toward opt-out HIV testing, while eleven favoured the approach. The remaining two participants had more nuanced perspectives that incorporated some characteristics of the questioning and favouring attitudes. Participants’ views about opt-out HIV testing largely fell into two contrasting themes: normalisation and routinisation versus exceptionalism; and a need for proof versus openness to new approaches. Conclusion Most HCPs in this study had dichotomous attitudes toward opt-out HIV testing, reflecting contrasting analytical styles. While some HCPs viewed it favourably, with the perceived benefits outweighing the perceived costs, others preferred to have evidence of efficacy and cost-effectiveness. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2229-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Stacy Leidel
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Ruth McConigley
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Duncan Boldy
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sally Wilson
- School of Nursing, Midwifery and Paramedicine, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Sonya Girdler
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
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HIV testing experience in New York City: offer of and willingness to test in the context of new legal support of routine testing. J Acquir Immune Defic Syndr 2015; 68 Suppl 1:S45-53. [PMID: 25545493 DOI: 10.1097/qai.0000000000000390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In the United States, routine HIV testing is recommended for persons aged 13-64 years. In 2010, New York State passed a law mandating offer of testing in most health-care settings. We report on the consumer perspective in New York City (NYC) shortly after the law's enactment. METHODS We analyzed data from a 2011 telephone survey representative of NYC adults aged 18-64 years (n = 1,846). This analysis focused on respondents' report of HIV test offer at last clinical visit and of willingness to test if recommended by their doctor. Offer and willingness were estimated by age, gender, race/ethnicity, education, income, marital status, sexual identity, partner number, and HIV testing history; associations were examined using multivariable regression. RESULTS Among NYC adults, 35.7% reported an HIV test in the past year and 31.8% had never tested. Among 86.7% with a clinical visit in the past year, 31.4% reported being offered a test at last visit. Offer was associated with younger age, race/ethnicity other than white, non-Hispanic, lower income, and previous testing. Only 6.7% of never-testers were offered a test at last clinical visit. Willingness to test if recommended was high overall (90.2%) and across factors examined. CONCLUSIONS After a new law was enacted in support of routine HIV testing, approximately 1 in 3 New Yorkers aged 18-64 years were offered a test at last clinical visit; 9 in 10 were willing to test if recommended by their doctor. This suggests that patient attitudes will not be a barrier to complete implementation of the law.
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14
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Meyerson BE, Navale SM, Gillespie A, Ohmit A. Routine HIV Testing in Indiana Community Health Centers. Am J Public Health 2015; 105:91-95. [PMID: 25393186 DOI: 10.2105/ajph.2014.302203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. We assessed routine HIV testing in Indiana community health centers (CHCs). Methods. CHC medical directors reported HIV services, testing behaviors, barriers, and health center characteristics via survey from April to May 2013. Standard of care testing was measured by the extent to which CHCs complied with national guidelines for routine HIV testing in clinical settings. Results. Most (85.7%) CHCs reported HIV testing, primarily at patient request or if the patient was symptomatic. Routine HIV testing was provided for pregnant women by 60.7% of CHCs. Only 10.7% provided routine testing for adolescents to adults up to age 65 years. Routine testing was reported by 14.3% for gay and bisexual men, although 46.4% of CHCs reported asking patients about sexual orientation. Linkage to care services for HIV-positive patients, counseling for HIV treatment adherence, and partner testing generally was not provided. Conclusions. Most CHCs reported HIV testing, but such testing did not reflect the standard of care, because it depended on patient request or symptoms. One approach in future studies may be to allow respondents to compare current testing with standard of care and then reflect on barriers to and facilitators of adoption and implementation of routine HIV testing.
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Affiliation(s)
- Beth E Meyerson
- Beth E. Meyerson and Shalini M. Navale are with Indiana University School of Public Health-Bloomington. Anthony Gillespie and Anita Ohmit are with Indiana Minority Health Coalition, Inc, Indianapolis
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Arya M, Patel S, Kumar D, Zheng MY, Kallen MA, Street RL, Viswanath K, Giordano TP. Why Physicians Don't Ask: Interpersonal and Intrapersonal Barriers to HIV Testing-Making a Case for a Patient-Initiated Campaign. J Int Assoc Provid AIDS Care 2014; 15:306-12. [PMID: 25421929 DOI: 10.1177/2325957414557268] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
In 2006, the US Centers for Disease Control and Prevention recommended HIV testing for all adolescents and adults aged 13 to 64 in health care settings with a HIV prevalence of at least 0.1%. However, 55% of US adults have never been tested and therefore do not know their HIV status. To understand suboptimal HIV testing rates, this study sought to illuminate interpersonal and intrapersonal physician barriers to HIV testing. One hundred and eighty physicians from health centers in Houston completed a survey based on Cabana's Knowledge, Attitudes and Behaviors model. One-third of the physicians faced at least 1 interpersonal barrier to HIV testing, such as a difference in age or language. Many (41%) physicians faced at least 1 intrapersonal barrier, such as believing their patients would be feeling uncomfortable discussing HIV. Notably, 71% of physicians would prefer their patients ask for the test. A patient-engaging campaign may be an innovative solution to increasing HIV testing and reducing the number of undiagnosed persons.
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Affiliation(s)
- Monisha Arya
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Sajani Patel
- Rice University, Houston, TX, USA Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Disha Kumar
- Rice University, Houston, TX, USA School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Micha Yin Zheng
- Rice University, Houston, TX, USA School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Michael A Kallen
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard L Street
- Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Thomas P Giordano
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX, USA Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, TX, USA
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16
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Hallmark CJ, Skillicorn J, Giordano TP, Davila JA, McNeese M, Rocha N, Smith A, Cooper S, Castel AD. HIV testing implementation in two urban cities: practice, policy, and perceived barriers. PLoS One 2014; 9:e110010. [PMID: 25310462 PMCID: PMC4195679 DOI: 10.1371/journal.pone.0110010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although funding has supported the scale up of routine, opt-out HIV testing in the US, variance in implementation mechanisms and barriers in high-burden jurisdictions remains unknown. METHODS We conducted a survey of health care organizations in Washington, DC and Houston/Harris County to determine number of HIV tests completed in 2011, policy and practices associated with HIV testing, funding mechanisms, and reported barriers to testing in each jurisdiction and to compare results between jurisdictions. RESULTS In 2012, 43 Houston and 35 DC HIV-testing organizations participated in the survey. Participants represented 85% of Department of Health-supported testers in DC and 90% of Department of Health-supported testers in Houston. The median number of tests per organization was 568 in DC and 1045 in Houston. Approximately 50% of organizations in both DC and Houston exclusively used opt-in consent and most conducted both pre- and post-test counseling with HIV testing (80% of organizations in DC, 70% in Houston). While the most frequent source of funding in DC was the Department of Health, Houston organizations primarily billed the patient or third-party payers. Barriers to testing most often reported were lack of funding, followed by patient discomfort/refusal with more barriers reported in DC. CONCLUSIONS Given unique policies, resources and programmatic contexts, DC and Houston have taken different approaches to support routine testing. Many organizations in both cities reported opt-in consent approaches and pre-test counseling, suggesting 2006 national HIV testing recommendations are not being followed consistently. Addressing the barriers to testing identified in each jurisdiction may improve expansion of testing.
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Affiliation(s)
- Camden J. Hallmark
- Houston Department of Health and Human Services, Houston, Texas, United States of America
- * E-mail:
| | - Jennifer Skillicorn
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC, United States of America
| | - Thomas P. Giordano
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jessica A. Davila
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, Texas, United States of America
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Marlene McNeese
- Houston Department of Health and Human Services, Houston, Texas, United States of America
| | - Nestor Rocha
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Avemaria Smith
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Stacey Cooper
- HIV/AIDS, Hepatitis, STD, and TB Administration, District of Columbia Department of Health, Washington, DC, United States of America
| | - Amanda D. Castel
- Department of Epidemiology and Biostatistics, School of Public Health and Health Services, George Washington University, Washington, DC, United States of America
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17
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Kintziger KW, Duffus WA. How useful is universal screening for HIV infection? A review of the evidence. Future Virol 2014. [DOI: 10.2217/fvl.13.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT: Our objective is to describe the current evidence for universal HIV screening in terms of the cost–effectiveness, acceptance rates and number of new positives identified. The available data demonstrate that universal HIV screening is cost-effective, in terms of quality-adjusted life years gained, increase in life expectancy of infected individuals and in reduced HIV transmission rates; and acceptable in healthcare settings based on acceptance (7–99%) and seropositivity (0–2%) rates. Specific studies are needed that address many of the other intended outcomes of universal screening programs, such as reducing number of missed opportunities, increased linkage to care and earlier disease stage detection. Also, additional studies with direct comparisons between universal and targeted testing are necessary to provide greater evidence for where either testing approach may be best implemented.
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Affiliation(s)
- Kristina W Kintziger
- Department of Biostatistics & Epidemiology, Medical College of Georgia, Georgia Regents University – Augusta, 1120 15th Street, Augusta, GA 30912, USA
| | - Wayne A Duffus
- Division of Infectious Diseases, University of South Carolina School of Medicine, 2 Medical Park, Columbia, SC 29203, USA
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18
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Azaroff LS, Davis LK, Naparstek R, Hashimoto D, Laing JR, Wegman DH. Barriers to use of workers' compensation for patient care at Massachusetts community health centers. Health Serv Res 2013; 48:1375-92. [PMID: 23445431 DOI: 10.1111/1475-6773.12045] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES To examine barriers community health centers (CHCs) face in using workers' compensation insurance (WC). DATA SOURCES/STUDY SETTING Leadership of CHCs in Massachusetts. STUDY DESIGN We used purposeful snowball sampling of CHC leaders for in-depth exploration of reimbursement policies and practices, experiences with WC, and decisions about using WC. We quantified the prevalence of perceived barriers to using WC through a mail survey of all CHCs in Massachusetts. DATA COLLECTION/EXTRACTION METHODS Emergent coding was used to elaborate themes and processes related to use of WC. Numbers and percentages of survey responses were calculated. PRINCIPAL FINDINGS Few CHCs formally discourage use of WC, but underutilization emerged as a major issue: "We see an awful lot of work-related injury, and I would say that most of it doesn't go through workers' comp." Barriers include lack of familiarity with WC, uncertainty about work-relatedness, and reliance on patients to identify work-relatedness of their conditions. Reimbursement delays and denials lead patients and CHCs to absorb costs of services. CONCLUSION Follow-up studies should fully characterize barriers to CHC use of WC and experiences in other states to guide system changes in CHCs and WC agencies. Education should target CHC staff and workers about WC.
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Affiliation(s)
- Lenore S Azaroff
- Occupational Health Surveillance Program, Massachusetts Department of Public Health, Boston, MA 02108, USA.
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Rizza SA, MacGowan RJ, Purcell DW, Branson BM, Temesgen Z. HIV screening in the health care setting: status, barriers, and potential solutions. Mayo Clin Proc 2012; 87:915-24. [PMID: 22958996 PMCID: PMC3538498 DOI: 10.1016/j.mayocp.2012.06.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 06/27/2012] [Accepted: 06/29/2012] [Indexed: 10/27/2022]
Abstract
Thirty years into the human immunodeficiency virus (HIV) epidemic in the United States, an estimated 50,000 persons become infected each year: highest rates are in black and Hispanic populations and in men who have sex with men. Testing for HIV has become more widespread over time, with the highest rates of HIV testing in populations most affected by HIV. However, approximately 55% of adults in the United States have never received an HIV test. Because of the individual and community benefits of treatment for HIV, in 2006 the Centers for Disease Control and Prevention recommended routine screening for HIV infection in clinical settings. The adoption of this recommendation has been gradual owing to a variety of issues: lack of awareness and misconceptions related to HIV screening by physicians and patients, barriers at the facility and legislative levels, costs associated with testing, and conflicting recommendations concerning the value of routine screening. Reducing or eliminating these barriers is needed to increase the implementation of routine screening in clinical settings so that more people with unrecognized infection can be identified, linked to care, and provided treatment to improve their health and prevent new cases of HIV infection in the United States.
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Affiliation(s)
| | - Robin J. MacGowan
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - David W. Purcell
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Bernard M. Branson
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Heffelfinger JD, Owen SM, Hendry RM, Lansky A. HIV testing: the cornerstone of HIV prevention efforts in the USA. Future Virol 2011; 6:1299-1317. [PMID: 37965646 PMCID: PMC10644277 DOI: 10.2217/fvl.11.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
An estimated 1.2 million persons in the USA are infected with HIV, of whom approximately 20% are unaware they are infected. HIV testing and knowledge of HIV serostatus have important individual and public health benefits, including reduction of morbidity, mortality and HIV transmission. Although testing is the necessary first step to prevention, more than half of the US adult population has never been tested for HIV. However, this proportion is increasing due to revised national recommendations to make HIV testing a routine part of healthcare, expansion of testing efforts at local, state and national levels, and progress in the development and adoption of new testing technologies. In this article, we describe the essential role of HIV testing as a public health prevention strategy, examine recent advances in HIV testing technologies and testing implementation, and identify future directions for HIV testing in the USA.
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Affiliation(s)
- James D Heffelfinger
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS: E-46, Atlanta, GA 30333, USA
| | - S Michele Owen
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS: E-46, Atlanta, GA 30333, USA
| | - R Michael Hendry
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS: E-46, Atlanta, GA 30333, USA
| | - Amy Lansky
- Division of HIV/AIDS Prevention, Centers for Disease Control & Prevention, 1600 Clifton Road, MS: E-46, Atlanta, GA 30333, USA
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