Table 2.
Barriers to Routine HIV Screening.
| Barrier title | Socioecological level |
|---|---|
| Costs/reimbursement | Public policy |
| Incompatibility of guidelines with state/local policies | Public policy |
| Legal issues | Public policy |
| Provider time constraints | Institutional |
| Managing care of patients who test positive | Institutional |
| Concerns about confidentiality | Institutional |
| Staffing shortage | Institutional |
| Difficulty following-up on test results | Institutional |
| Materials needed for testing | Institutional |
| Clinical inertia | Institutional |
| Lack of administrative support | Institutional |
| Logistical difficulties | Institutional |
| Need for patient-friendly educational materials | Institutional |
| Quality assurance concerns | Institutional |
| Administrative burden of testing | Institutional |
| Stigma | Interpersonal |
| Culture/language/sexual orientation/gender/race/age | Interpersonal |
| Difficulty testing adolescents | Interpersonal |
| Lack of established patient–provider relationship | Interpersonal |
| Patient discomfort discussing HIV and risk factors | Interpersonal |
| Family and partner dynamics interfere with testing | Interpersonal |
| Pre-/posttest counseling and consent process | Intrapersonal |
| Competing clinical priorities | Intrapersonal |
| Perception of low HIV prevalence or patient risk | Intrapersonal |
| Lack of awareness of guidelines | Intrapersonal |
| Perception of patient discomfort with/reluctance to test | Intrapersonal |
| Provider discomfort discussing HIV/risk behaviors | Intrapersonal |
| Lack of self-efficacy providing positive test result | Intrapersonal |
| Lack of provider knowledge about HIV | Intrapersonal |
| Testing considered outside scope of practice | Intrapersonal |
| Fear of offending patients | Intrapersonal |
| Patient perception of low-risk | Intrapersonal |
| Lack of familiarity with HIV test procedures | Intrapersonal |
| Belief that HIV should be relegated to specialists | Intrapersonal |
| Concerns about cost-effectiveness | Intrapersonal |
| Additional training needed | Intrapersonal |
| Patient acuity | Intrapersonal |
| Lack of support for HIV as a public health issue | Intrapersonal |
| Concern about false-positive results | Intrapersonal |
| Forgetting to test | Intrapersonal |
| Personal disagreement with routine testing recommendations | Intrapersonal |
| Testing is seen as coercive to the patient | Intrapersonal |
| Testing seen as not a priority to patients | Intrapersonal |
| Belief that patients should request screening | Intrapersonal |
| Patients’ fear of needles prevents blood draws | Intrapersonal |
| Lack of efficacy of test to change patient behavior | Intrapersonal |