First name
Nellie
Last name
Lazar

Title

Using Chart-Stimulated Recall to Identify Barriers and Facilitators to Routine HIV Testing Among Pediatric Primary Care Providers.

Year of Publication

2019

Date Published

2019 Jun 24

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>Adolescents account for one in five new HIV infections in the U.S. Yet, only 25% of sexually active adolescents report HIV testing, and testing rates have not improved over time. In this study, the primary aim was to identify barriers and facilitators to routine HIV testing in the pediatric primary care setting.</p>

<p><strong>METHODS: </strong>Practices within a large pediatric network were stratified by higher and lower rates of HIV testing. Providers were purposively sampled across practices, and chart-stimulated recall was used to explore HIV testing knowledge and practices by having providers review actual adolescent well visit records. Interviews were audio-recorded and transcribed. Qualitative content analysis identified categories of barriers and facilitators to HIV testing among higher and lower performing sites.</p>

<p><strong>RESULTS: </strong>Of participants (n&nbsp;= 31), 52% were from higher performing clinics, and 48% from lower performing clinics, and mean number of years in practice was 16.9 (standard deviation 10.8). Provider-identified barriers at lower-performing sites included lack of knowledge of testing guidelines, inadequate sexual risk assessment, concerns about damaging patient/caregiver relationships, and competing priorities, whereas both high- and low-performing cites reported concerns about confidentiality. Identified facilitators at higher performing sites included availability of on-site resources (Title X funding; laboratory).</p>

<p><strong>CONCLUSIONS: </strong>Several distinct barriers and facilitators to routine HIV screening were identified at lower and higher performing sites. These findings can inform the development of multilevel interventions to improve HIV testing rates in pediatric primary care.</p>

DOI

10.1016/j.jadohealth.2019.04.005

Alternate Title

J Adolesc Health

PMID

31248806

Title

Missed Opportunities for HIV Screening Among a Cohort of Adolescents With Recently Diagnosed HIV Infection in a Large Pediatric Hospital Care Network.

Year of Publication

2018

Date Published

2018 Oct 02

ISSN Number

1879-1972

Abstract

<p><strong>PURPOSE: </strong>Routine human immunodeficiency virus (HIV) screening reduces HIV progression and transmission. Our aims were to determine prevalence and factors associated with prior HIV screening among a cohort of youth living with HIV.</p>

<p><strong>METHODS: </strong>Retrospective chart review of youth living with HIV aged 14-26 at an HIV clinic comparing characteristics between those with and without HIV screening within the year prior to diagnosis RESULTS: Subjects (n = 301) were male (85%), African-American (87%), and men who have sex with men (84%). Subjects seen 1 year prior to diagnosis (n = 58) contributed 179 visits for missed opportunities with 59% having a documented sexual history in the electronic health record and 48% tested for HIV. Subjects with symptoms suggesting acute HIV infection (51%) were more likely to be tested (p = .04). In the adjusted model, documentation of sexual history and demographic factors was not associated with prior testing.</p>

<p><strong>CONCLUSION: </strong>We identified high rates of missed opportunities for HIV testing and sexual history documentation in the year prior to diagnosis, underscoring the need for routine HIV screening in adolescents.</p>

DOI

10.1016/j.jadohealth.2018.07.010

Alternate Title

J Adolesc Health

PMID

30290980

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