ArticlePolicyRecommendations and reality: Perceived patient, provider, and policy barriers to implementing routine HIV screening and proposed solutions
Section snippets
CDC Recommendations on HIV Testing
In light of the changing shape of the epidemic, the Centers for Disease Control and Prevention (CDC) released revised recommendations for HIV testing calling for routine HIV testing to be offered to those ages 13 to 64 in all health care settings as a standard component of general health care.13 Important changes included in this recommendation include eliminating the endorsement of a separate written consent form before an HIV test can be performed, instead calling for HIV testing to be
Perceived Patient Barriers
Although there is evidence that negative attitudes, beliefs, and policies directed toward those perceived to have HIV have declined over the years, HIV-related stigma and mental health sequelae from stigma remains the most significant barriers to routine HIV testing from a patient perspective.17 More than one-third of those surveyed in a poll conducted by the Kaiser Family Foundation reported they would feel “very” or “somewhat” concerned that people would think less of them if they learned
Summary
Barriers to the CDC’s recommendation for routine testing from a patient, provider, and policy perspective are complex (Table 2) and require solutions in which nurse leaders can transform barriers to opportunities. Concentrated, sensitive, and respectful efforts must advance solutions that recognize state power, the abject perceived and real fears of stigma and discrimination, and the need to find ways to develop payment for screening kits and to expand linkages for services after a positive
Acknowledgments
Thanks to the members of the American Academy of Nursing, Emerging and Infectious Disease Expert Panel for their supportive suggestions.
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An automated best practice advisory increases both routine HIV screening and HIV cotesting with sexually transmitted infections in the emergency department
2024, American Journal of Infection ControlNurses perceptions about their behavioural counselling for HIV/AIDS, STIs and TB in eThekwini Municipality clinics KwAZulu-Natal, South Africa
2017, Health SA GesondheidCitation Excerpt :It is within this context that many of those infected seek treatment at public sector facilities, where counselling forms an important part of their on-going testing and treatment schedule (Kanekar, 2011). This interaction is conducted by nurses, who are at the forefront of combatting these co-infections (DeMarco, Gallagher, Bradley-Springer, Jones, & Visk, 2012). Extensive training was undertaken to not only ensure that accurate information was provided to patients, but to ensure that they all receive quality services (Roura, Watson-Jones, Kahawita, Ferguson, & Ross, 2013).
The role of nurses in HIV screening in health care facilities: A systematic review
2014, International Journal of Nursing StudiesCitation Excerpt :In addition to nurse participation in and enthusiasm for the screening process, its implementation was facilitated by the ease of HIV test administration, the possibility of structuring rapid testing during nonpeak hours, the provider interest in HIV and prevention, and a multidisciplinary approach with the involvement of managers and other health care staff (Chen et al., 2011; d’Almeida et al., 2013; Leblanc et al., 2012). Nine studies documented organisational barriers, such as insufficient time, legal limitations, lack of knowledge of recommendations and costs (Anaya et al., 2013; Clerk et al., 2013; Costello et al., 2013; d’Almeida et al., 2013; deMarco et al., 2012; McNaghten et al., 2014; Mumma and Suffoletto, 2011; Walensky et al., 2011; White et al., 2009). Additional major barriers for staff members were the concern over delivering a positive test result (Hecht et al., 2011; Leblanc et al., 2012; Thornton et al., 2012) and uneasiness when discussing sensitive topics, such as risk factors, with patients or discomfort with maintaining confidentiality (Anaya et al., 2012; Arbelaez et al., 2012; Chen et al., 2011; Hecht et al., 2011; Kinsler et al., 2013; Rayment et al., 2012; Thornton et al., 2012).
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2014, Nursing OutlookIntegrating Routine HIV Screening Into a Primary Care Setting in Rural North Carolina
2014, Journal of the Association of Nurses in AIDS CareCitation Excerpt :When the clinic was particularly busy, when they were running behind schedule, or when emergent issues arose, the testers felt there was insufficient time to perform the test. Lack of time has been cited in the literature as a barrier to routine testing (Demarco, Gallagher, Bradley-Springer, Jones, & Visk, 2012; Thornton et al., 2012). In a recent study of routine HIV testing in a PCC that reported a low rate of HIV testing (8.75%), a survey of health care workers who participated in testing revealed that busy days or days when the clinic was short-staffed resulted in fewer tests being offered (Valenti, Szpunar, Saravolatz, & Johnson, 2012).
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