Pediatric Primary Care Providers' Attitudes Towards Routine, Opt-Out HIV Testing

Background: In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine Human Immunodeficiency Virus (HIV) testing in all patients 13-64 years old, regardless of risk factors. UCSF Benioff Children’s Hospital Oakland is the second pediatric institution in the United States to implement routine opt-out HIV testing. A serum antibody+antigen detection assay was chosen as the screening test. Despite several interventions to educate providers on the initiative and an overall offer rate of 73%, our primary care testing rates have remained low (20% of eligible patients). This study aimed at elucidating providers' reasons for not testing all eligible patients.

Methods: Attending physicians and pediatric residents completed a voluntary web-based survey on attitudes towards HIV testing in primary care clinics, reasons for not offering HIV testing to eligible patients, experiences offering routine HIV testing with parents in the room, and suggestions for improving testing rates.

Results: 38 residents and 10 attending physicians completed the survey (61% and 50% of those surveyed, respectively). Providers perceived that offering opt-out HIV testing added only 1-2 minutes to their workflow. 75% agreed with routine HIV testing starting at age 13 or 14. The majority felt "very comfortable" offering testing; most providers reported positive experiences discussing HIV testing with parents, too. The 3 main reasons chosen for not offering routine HIV testing to an eligible patient were: "It's a focused visit/sick visit, I deferred it to the next physical" (58%), "I meant to offer it, but then I forgot" (42%) and "I don't want to add significant time to the visit" (35%). The two most common suggestions for increasing testing rates were “Shorter wait times for phlebotomy" (33%) and offering use of “a point of care test” (33%).

Conclusion: Most respondents agreed with the need for routine HIV testing starting in early adolescence. They felt comfortable discussing the test with patients and families. Areas for improvement include educating providers to test even during sick visits; devising more effective reminders that HIV testing is indicated; and expediting testing by increasing phlebotomy staff or identifying and utilizing a more effective point of care test.