October 22, 2012
Researchers reported on two studies at a poster session of IDWeek 2012, a joint meeting of the Infectious Disease Society of America (IDSA), the Society for Health and Epidemiology of America (SHEA), the HIV Medicine Association (HIVMA), and the Pediatric Infectious Diseases Society (PIDS). The studies exposed medical practitioners' reluctance to ask patients to take the test as a major barrier to universal HIV testing, which is recommended by national, state, and local institutions.
A study by Marelle Yehuda, M.D., an internal medicine resident at Lenox Hill Hospital, New York, and others reviewed records of 134 patients admitted during June 2011 and identified 87 who met criteria for HIV screening. Only eight of these patients were asked about HIV screening. Yehuda and colleagues surveyed medical residents to determine their knowledge of HIV screening criteria and their attitudes toward screening. The results showed that 81 percent were not familiar with the CDC recommendation that all patients should be screened for HIV infection nor the 2010 New York State legislative mandate that required patients be offered screening; 75 percent understood the difference between "opt in" and "opt out" testing; 43 percent believed written consent was necessary for rapid testing; and 38 percent did not know how to order the rapid HIV screening test. The residents provided three reasons for not pursuing HIV testing: they were too busy, thought the test not clinically relevant, or believed the patient was not at risk. These results led to the hospital implementing a series of interventions to improve the HIV screening rate, including educating residents, reminders on electronic medical records, and simplifying the test order form.
In another study at the University of Chicago, Sara Bares, M.D., found that doctors did not ask patients to take the HIV test. A survey of 259 residents in a six-week period resulted in 162 responses (63 percent). Less than 32 percent of the residents in an outpatient clinic asked patients about HIV screening, 24 percent working with in-patients asked, and 16 percent in the emergency department asked. Many said that they did not ask because they thought that patients would refuse. David Pitrak, M.D., chief of infectious diseases at the University of Chicago and senior investigator in this study, commented that one reason physicians do not ask patients to be tested for HIV is that the physicians may not be able to properly counsel patients who test positive. Dr. Pitrak explained that at the University of Chicago, only infectious disease staff members follow up on positive test results. A coordinator finds the individuals who tests positive to schedule their appointments.