Perceived Barriers to HIV Screening Among Primary Care Providers
Escher L. Howard-Williams, De-Vaughn Williams, Patricia Knoepp, Sydney Tucker, Beyla Patel, Louise KingBackground
The 2019 U.S. Preventive Services Task Force (USPSTF) recommends universal HIV screening for adults aged 15–65 years, yet most eligible patients are never offered testing. This study assessed HIV screening practices and perceived barriers among primary care providers in a Southern U.S. academic-affiliated health system.
Methods
A cross-sectional online survey of predominantly close-ended items with a small number of open-ended items, was distributed to approximately 406 primary care providers (physicians, nurse practitioners, and physician assistants) in November 2024, assessing guideline awareness, screening practices, and perceived barriers. Close-ended responses were summarized with descriptive statistics; open-ended responses underwent inductive content analysis.
Results
Forty providers completed the survey (9.85% response rate). Twenty-one of 40 were aware of the 2019 USPSTF guidelines, and 17 of 40 reported offering screening to all patients aged 15–65 often or always. Although 34 of 40 agreed screening is important, 27 of 40 believed patients do not anticipate being offered testing, and only 26 of 40 were confident in managing a positive result despite 36 of 40 being confident ordering the test. Leading barriers included anticipated patient refusal, competing priorities, limited visit time, and low perceived patient risk. An electronic health record (EHR) reminder was the most-endorsed intervention (33 of 40).
Conclusions
Providers value HIV screening but face addressable implementation barriers, including a gap between confidence in ordering tests and confidence in managing positive results. EHR reminders, opt-out testing to normalize screening, and clear post-test management and linkage-to-care education represent evidence-based strategies to improve guideline-concordant screening.