Abstract
In 2006, the Centers for Disease Control and Prevention (CDC) endorsed routine voluntary HIV testing in health care settings to identify the many HIV-infected but undiagnosed persons. Realizing this goal will require primary care providers including internal medicine physicians to order HIV tests routinely. In particular, urban internal medicine trainees who work in high HIV prevalence settings need to adopt this approach. We therefore examined the practice of routine HIV testing and to identify factors that correlate with offering HIV testing to this group. We conducted a self-administered electronic cross-sectional survey of New York City's (NYC) internal medicine residents on HIV testing-related knowledge, attitudes, and behaviors with 29 close-ended questions. Fifteen of 42 NYC internal medicine residency programs participated in early 2007. Of 1175 residents, 450 (38.3%) responded. Most (64.1%) ordered 10 or less HIV tests in the past 6 months; 32.6% were aware of the 2006 guidelines; 35.8% utilized a routine testing approach. Respondents aware of current guidelines were more likely to practice routine testing (odds ratio [OR] 3.7, 95% confidence interval [CI]: 2.4–5.6). Two common barriers to testing were procedural: time-consuming consent process (27.1%); difficulty locating consent forms (19.3%). Most (68.4%) respondents indicated that oral consent would facilitate more testing. Most NYC internal medicine residents are not routinely offering HIV tests as advised by the 2006 CDC HIV testing guidelines and continue to test patients according to perceived patient HIV risk. This is likely contributing to their low testing rates. Most identified institutional and policy barriers to routine testing. Efforts should be made to improve dissemination of guidelines and address institutional and policy barriers to allow more people to learn their HIV status.