TABLE II.

Perceptions of Barriers and Facilitators to Routine HIV testing among North Carolina Primary Care Physicians (N=18)

Level	BARRIERS	FACILITATORS
Policy	Lack of insurance coverage Parental consent needed for children (including adolescents)	Third Party reimbursement Elimination of written HIV consent U.S Preventive Services Task Force recommendation (USPSTF) Streamline HIV counseling Require HIV testing for college enrollment Require physicians to routinely test
Community	Social Stigma Lack of public acceptance Socially and politically conservative communities	Decrease stigma Public campaigns to encourage patient acceptance
Practice	Nursing resistance Employer policies not consistent with the 2006 CDC recommendations Lack of time Lack of provider reimbursement for time involved in counseling Oral HIV tests HIV testing and primary care at different locations Small practices (less likely to be up to date on new recommendations)	Nurse and staff initiated HIV screening and counseling Educate medical directors, nurses and office staff about HIV testing recommendations Systems to routinize HIV testing into the clinical workflow Use of oral HIV tests Decrease stigma Screen for HIV during initial or wellness visit Include HIV testing as part of an STD panel University practice setting more likely to be up to date on new recommendations
Physician	Competing clinical priorities Misperceptions regarding HIV risk Stigma about HIV Unawareness of HIV as a problem in their community Clinician inertia Discomfort communicating about HIV testing Belief that routine HIV testing is not cost effective	Physician education (HIV prevalence, HIV screening recommendations) Increase physician awareness of HIV prevalence in the communities where they practice Patient request for routine HIV screening USPSTF level A recommendation to routinely screen for HIV
Patient	Lack of education about HIV/AIDS Lack of time Stigma Fear of Needles Fear of being HIV positive Patient costs associated with HIV testing Fear of losing confidentiality Patient refusal Older patients (more likely to refuse routine HIV testing) Patients do not think they are at risk for HIV	Educate patients about HIV risk Increase patient acceptance of HIV screening Adopt universal HIV testing Patient request Younger age (more likely to accept HIV routine testing)