Table 3.
Barriers to HIV Testing Identified by General Internal Medicine Physicians who Provide HIV Testing in Outpatient Settings
| Specific barriers to testing (% agree to each barrier) | Overall (n = 394) | Access to rapid HIV testing | P-Value | |
|---|---|---|---|---|
| Yes (n = 61) | No (n = 333) | |||
| Patient barriers | ||||
| Patient reluctance/refusal | 250 (63.5%) | 36 (59.0%) | 214 (64.3%) | 0.43 |
| Language barrier | 124 (31.5%) | 19 (31.1%) | 105 (31.5%) | 0.95 |
| Cultural difference between you and your patient | 86 (21.8%) | 12 (19.7%) | 74 (22.2%) | 0.66 |
| Your patients don't have high-risk behaviors | 115 (29.2%) | 9 (14.8) | 106 (31.8%) | 0.007** |
| Patients uncomfortable discussing HIV testing | 104 (26.4%) | 16 (26.2%) | 88 (26.4%) | 0.97 |
| Lack of trust/relationship with patient | 52 (13.2%) | 8 (13.1%) | 44 (13.2%) | 0.98 |
| Discomfort discussing high-risk behaviors with your patients | 23 (5.8%) | 5 (8.2%) | 18 (5.4%) | 0.39 |
| Gender difference between you and your patient | 7 (1.8%) | 1 (1.6%) | 6 (1.8%) | 0.70 |
| Difference in sexual orientation between you and your patient | 7 (1.8%) | 0 (0.0%) | 7 (2.1%) | 0.39 |
| Structural barriers | ||||
| Lack of/low reimbursement | 64 (16.2%) | 6 (9.8%) | 58 (17.3%) | 0.14 |
| Other priorities at time of visit | 310 (78.7%) | 38 (62.3%) | 272 (82.2%) | <0.001** |
| Lack of time | 252 (64.0%) | 34 (55.7%) | 218 (65.5%) | 0.13 |
| Confidentiality | 31 (7.9%) | 5 (8.2%) | 26 (7.8%) | 0.93 |
| No place to refer patients with positive test | 7 (1.8%) | 2 (3.3%) | 5 (1.5%) | 0.60 |
| Lack of skills or training in this area | 10 (2.5% | 3 (4.9%) | 7 (2.1%) | 0.37 |
| Not your job; someone else is doing it | 1 (0.3%) | 0 | 1 (0.3%) | 0.85 |
| HIV is not a major issue in your community | 29 (7.4%) | 2 (3.3%) | 27 (8.1%) | 0.28 |
| Lack of clinic space | 7 (1.8%) | 1 (1.6%) | 6 (1.8%) | 1.00 |
| Clinic barriers | ||||
| Informed consent requirement | 193 (49.0%) | 24 (39.3%) | 169 (51.1%) | 0.09 |
| Pre-test counseling requirement | 146 (37.1%) | 18 (29.5%) | 128 (38.7%) | 0.17 |
| Lack of staffing | 68 (17.3%) | 10 (16.4%) | 58 (17.5%) | 0.83 |
| Testing low-risk established pts | 134 (34.0%) | 11 (18.0%) | 123 (37.2%) | 0.004** |
| Concerns about clinic confidentiality | 50 (12.7%) | 8 (13.1%) | 42 (12.7%) | 0.93 |
| Our system of scheduling patient follow-up | 97 (24.6%) | 12 (9.7%) | 85 (25.7%) | 0.32 |
| Lack of training in how to offer routine testing | 33 (8.3%) | 6 (9.8%) | 27 (8.2%) | 0.66 |
| Rapid testing not available | 146 (37.1%) | 3 (4.9%) | 143 (43.2%) | <0.001** |
| No patient barriers | 80 (20.3%) | 18 (29.5%) | 62 (18.6%) | 0.05 |
| No structural barriers | 49 (12.5%) | 14 (23.0%) | 35 (10.6%) | 0.007** |
| No clinic barriers | 75 (19.0%) | 20 (32.8%) | 55 (16.5%) | 0.002** |
**P < 0.01