Clinician Barriers and Facilitators to Routine HIV Testing: A Systematic Review of the Literature.

Abstract

Background Routine HIV screening rates are suboptimal.

Objectives This systematic review identified barriers to/facilitators of routine HIV testing, categorized them using the socioecological model (SEM), and provided recommendations for interventions to increase screening. Data sources Included articles were indexed in PubMed, EBSCO CINAHL, Scopus, Web of Science, and the Cochrane Library between 2006 and October 2018. Eligibility criteria Included studies were published in English or Spanish and directly assessed providers' barriers/facilitators to routine screening. Data extraction We used a standardized Excel template to extract barriers/facilitators and identify levels in the SEM. Data synthesis Intrapersonal factors predominated as barriers, while facilitators were directed at the institutional level. Limitations Policy barriers are not universal across countries. Meta-analysis was not possible. We could not quantify frequency of any given barrier/facilitator.

Conclusions Increasing reimbursement and adding screening as a quality measure may incentivize HIV testing; however, many interventions would require little resource investment.