Opt-Out HIV Testing in U.S. Tuberculosis Clinics: A Survey of Current Practice and Perceived Barriers

Transcription

1 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 16 th Conference of The Union North American Region (2012) in San Antonio, TX Manuscript is in progress 1

2 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 2

3 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: Patients with active TB disease Patients with LTBI Patients with contact to a patient with active TB disease Patients suspected to have active TB disease Unimportant Of little importance Neither important nor unimportant Important Very Important 3

4 Results: Current Practice In your clinic, are patients with the following diagnoses routinely tested for HIV? Active TB disease Latent TB infection Contact to a patient Patient suspected to with active TB disease have active TB disease Yes, always Yes, almost always Yes, sometimes Yes, rarely No, never 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 Not enough available space Administrative burden Requires too much provider time Patient failure to return for results Staff unwilling Staff not qualified No easily accessible HIV referral site Prevalence too low to justify Too many false positives Cost Yes Testing Not Testing No 4

5 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 39.90% 43.70% No Already routinely test all patients for HIV 16.50% 5

6 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) Caitlin_Naureckas@brown.edu Adrian Gardner MD, MPH adriangardner1@gmail.com E. Jane Carter MD E_Jane_Carter@brown.edu 6