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.