Transcript Opt-Out HIV Testing in U.S. Tuberculosis Clinics: A Survey

Opt-Out HIV Testing in U.S.
Tuberculosis Clinics: A
Survey of Current Practice
and Perceived Barriers
Adrian Gardner MD, MPH
Assistant Professor of Clinical Medicine, Infectious Diseases, Indiana University School of Medicine
Assistant Professor of Clinical Medicine (Adjunct), Alpert School of Medicine at Brown University
Visiting Lecturer, Moi University School of Medicine, Eldoret, Kenya
Disclosures
• No relevant conflicts of interest
• Survey conducted and analyzed by Caitlin
Naureckas as part of her senior undergraduate
thesis work (Brown University)
• Presented at the 16th Conference of The Union
North American Region (2012) in San Antonio,
TX
• Manuscript is in progress
Methods
• Online Survey Monkey® survey designed to
assess the extent of opt-out HIV testing as
well as TB providers’ knowledge and
perceptions of the current CDC guidelines
• No comprehensive list of TB providers in US
• Survey was sent to 2011 National TB
Conference attendees, National TB Nurse
Controllers, and the CDC’s TB-educate mailing
list
Results and Limitations
• 158/2522 (6.3%) responded
– Self-selected group (? bias)
– Limited generalizability of conclusions
Results: Demographic characteristics
of respondents
• Occupation
– 91 (59.5%) nurses
– 30 (19.6%) physicians
– 19 (12.4%) public health practitioners
– 13 (8.5%) other
• Geography
– 39 states were represented
• Experience
– 104 (66%) reported >5 years in TB care
Results: How important is HIV Testing?
How important do you think it is to test for HIV in:
180
160
Unimportant
140
Of little
importance
Neither important
nor unimportant
Important
120
100
80
60
40
20
Very Important
0
Patients with active Patients with LTBI
Patients with
Patients suspected
TB disease
contact to a patient to have active TB
with active TB
disease
disease
Results: Current Practice
In your clinic, are patients with the following diagnoses routinely tested for HIV?
Yes, always
180
Yes, almost
always
Yes, sometimes
160
140
120
Yes, rarely
100
No, never
80
60
40
20
0
Active TB disease
Latent TB infection
Contact to a patient
Patient suspected to
with active TB disease have active TB disease
141 (92.2%) reported pts with TB disease were “always”/ “almost always” HIV tested
65 (42.5%) for LTBI patients
58 (36.7%) for all patients seen in TB clinic
Results: Barriers
Which of the following would be/are barriers to incorporation of routine, opt-out HIV
testing for ALL TB patients in your clinic? Please select Yes/No for each answer.
Burden of obtaining consent
✓✓
Patient refusal of test
Patient discomfort with finger stick or…
Disruptive of patient flow
No lab space available
Yes
Not enough available space
No
Administrative burden
Requires too much provider time
Patient failure to return for results
Staff unwilling
✓ Testing
Staff not qualified
No easily accessible HIV referral site
✓ Not Testing
✓
Prevalence too low to justify
Too many false positives
✓
Cost
0
50
100
150
200
Results: Informed Consent for Testing
• 59 (38.6%) respondents reported their state
required written consent for HIV testing
– 12 of those (7.8% of total respondents) are from
states that actually required written consent at the
time of survey distribution
• One (0.7%) respondent from a state with laws
requiring written consent stated it was not
compulsory
• 7 (4.6%) reported they did not know whether
written consent was required
Results: Perceived Feasibility
Do you think routine, opt-out testing would be
feasible and acceptable in your setting?
Yes
No
39.90%
16.50%
43.70%
Already routinely test all patients for
HIV
Conclusions
• Significant work must be done to promote the integration
of opt-out HIV testing into routine care of all patients
affected by TB—by either infection or disease
• Fewer than half of respondents’ care settings have an optout HIV testing policy for LTBI patients, indicating a true
missed opportunity
• Although providers tend to report acceptance of the need
for universal testing of TB affected patients, they cite a long
list of barriers, some of which are no longer valid (i.e. HIV
consent procedures by state)
– This represents a teachable moment as well a potential funding
partnership for TB care
Contact Information
• Caitlin Naureckas MD (2016)
– [email protected]
• Adrian Gardner MD, MPH
– [email protected]
• E. Jane Carter MD
– [email protected]