1. Poster produced by Faculty & Curriculum Support (FACS), Georgetown University Medical Center
HIV testing practices among providers in Washington D.C.
Christina Hanna, BS1
; Isla McClelland, BS1
; Sofija Degesys, BA1
;
Mary Beth Levin, MPH1
; Eileen Moore, MD2
Abstract
1
Georgetown University School of Medicine, Washington, DC;
2
Department of Medicine, Georgetown University Hospital, Washington, DC
Introduction
Project to Date
Going Forward
References
Acknowledgments
Georgetown
University
1. Why Aren’t D.C. Doctors Testing for HIV?" Global Business Coalition on HIV/AIDS, Tuberculosis and
Malaria. 17 Nov. 2010. Web. <http://www.gbcimpact.org/node/2897>.
2. District of Columbia HIV/AIDS Epidemiology Update 2008. Rep. Washington, D.C.: D.C. Department of
Health, 2008. Print.
3. District of Columbia HIV/AIDS Behavioral Surveillance Summary Report 2008. Rep. Washington, D.C.:
D.C. Department of Health and George Washington University School of Public Health and Health
Services, 2008. Print.
4. Branson, Bernard M., et. al. "Revised Recommendations for HIV Testing of Adults, Adolescents, and
Pregnant Women in Health Care Settings." CDC MMWR Recommendations and Reports. Center for
Disease Control, 22 Sept. 2006. Web. <http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5514a1.htm>.
5. D.C. Department of Health Offer the Test Pilot Study. 17 Mar. 2011. Raw data. D.C. Department of
Health, Washington, D.C.
Background Information
Both the D.C. Department of Health and the CDC recommend
providers use opt-out HIV testing for all adults, adolescents
and pregnant patients. Unfortunately, lack of adherence to
these recommendations can have serious consequences as
patients unaware of their HIV status will have later diagnoses,
which correlates with worse medical outcomes. The D.C.
HIV/AIDS Administration distributed a survey to 4000 providers
in the district through a program called Offer the Test.1
The
goal of Offer the Test is to assess provider practices,
knowledge of and perceived barriers to routine HIV testing. The
results of the survey will act as a pilot study for the
implementation of Offer the Test at Georgetown. Building on
the city-wide survey we will administer the questionnaire
through the preceptorship program to expand the respondent
pool and involve medical students in the discussion of this
important health issue. In this way we can address gaps in
knowledge and implementation to improve the routine testing
rate which will benefit undiagnosed HIV-positive D.C. patients.
HIV is a prominent problem in Washington D.C. and according
to the D.C. Department of Health 2008 Epidemiology Update 3%
of district residents are currently living with HIV/AIDS. As many
as 1/3 to 1/2 of these residents are unaware of their diagnosis.1,2
Furthermore data from the D.C. HIV Health Behavior Study3
showed that 75% of newly diagnosed patients had been to at
least one medical provider in the past 12 months but had not
been diagnosed.
One of the most effective prevention methods is to implement
HIV screening for all adolescents and adult patients and the
D.C. Department of Health maintains a policy that routine opt-
out HIV testing in medical settings is the district’s standard of
care. This is in support of the CDC September 2006 revised
recommendations4
for HIV testing in all adults, adolescents and
pregnant women in health care settings. This study will
investigate provider knowledge, current HIV routine testing
practices and perceived barriers to routine testing.
This year our group has collaborated with the George
Washington University Medical School, the Global Business
Coalition, the D.C. Department of Health and the CDC. We
have developed a survey that has been distributed to D.C.
providers as part of the Offer the Test program. One arm of this
project is aimed at involving medical students in the distribution
of the survey and thereby initiating the discussion of routine HIV
testing with their mentors (current D.C. providers) increasing
both student and provider knowledge. Now having observed the
student involvement of Offer the Test at George Washington
Medical School we are hoping to integrate the student initiative
into the curriculum here at Georgetown. To this end we have
finalized the survey, completed and submitted an IRB and are
discussing methods of implementation.
In the coming year we will roll out the Offer the Test program
here at Georgetown. We will provide an introduction to the first
and second year students regarding routine HIV screening and
the importance of their role in advocating for this concerning
health issue. We hope to discuss survey logistics and distribute
the questionnaire through the Ambulatory Care (AC) course to
the first and second year medical students. Ideally, the students
will go through the survey with their preceptors during one of the
AC sessions. The surveys will be returned to the corresponding
educational coordinator of the course who will de-identify and
code the questionnaire.
Following collection of the survey and the simultaneous
completion of the AC course we will analyze the data which we
hope will provide valuable insight into the current practices of
HIV screening. In addition the survey has been structured such
that it can increase both provider and student knowledge of CDC
recommendations.
In 2010 the D.C. Department of Health distributed a survey to
4000 providers in the district as part of a broad effort to urge
them to offer routine HIV screening. Physicians were asked to
complete a 15-question online survey that focused on 4 key
areas:
1.Provider & Patient Demographics
The survey yielded results from 103 providers. The majority of
respondents were internists (30%) or physician assistants
(27%). On average providers reported that their patient
population primarily consisted of African Americans (48.6%),
Caucasians (26.9%) , and Hispanic/Latino (14.2%). This is in
line with the general D.C. patient population. Lastly, in terms of
reimbursement 42.7% were covered by private insurance,
32.1% were covered by Medicaid, 19.8% were covered by
Medicare and 7.4% were out of pocket. This is a representative
cross-section of D.C. insurance types.5
2.Provider Understanding of HIV/AIDS in D.C.
72% of health care providers surveyed do not know the severity
of the D.C. HIV/AIDS. Only 28% correctly stated that all four
quadrants of the district meet the World Health Organization’s
threshold for a “generalized and severe” HIV epidemic.5
3.Provider Testing Practices
91% of healthcare providers surveyed agree that it is important
to incorporate routine HIV screening in the medical care of their
patients. However, only 21% of healthcare providers surveyed
report that they provide HIV tests to 90% or more of their
patients. The primary barriers (Fig. 1) to routine testing cited by
providers included 1)limited time to perform HIV counseling,
2)limited to perform testing for HIV and 3)cost or reimbursement
concerns.5
4.Provider Knowledge of Testing Guidelines
CDC recommendations (Fig. 2A): 85.8% of providers surveyed
stated that they were aware of the CDC guidelines that all
patients ages 13-64 be tested for HIV in all healthcare settings
after the patient is notified and consents (opt-out testing) and
annually for high risk patients. However, only 56.6% of these
providers were implementing these recommendations.
D.C. Department of Health (Fig. 2B): 68.9% of providers were
aware of the D.C. DOH recommendations that all D.C. residents
between the ages of 13 and 84 should be tested annually and
all men having sex with men (MSM) should be tested every 6
months. However, only 49.1% were implementing these
guidelines.5
Fig. 1. D.C. Department of Health survey5
. These data indicate that primary barriers to routine HIV testing cited by providers.
A
B
56.6%29.2%
14.2%
49.1%
19.8%
31.1%
Fig. 2. D.C. Department of Health survey5
. (A) The CDC
recommends that all patients ages 13-64 be tested for HIV in all
healthcare settings after the patient is notified and consents (opt-
out testing) and annually for high risk patients. (B) The D.C. DOH
recommends that all patients ages 13-84 should be tested
annually and all MSM should be tested every 6 months.
We would like to thank Professor Mary Beth Levin
(GUSOM), Dan O’Neill (GWUHS), Michael Kharfen
(DOH) and Dr. Eileen Moore (GUH)