Barriers to HIV testing in hospital settings within a culturally diverse urban district of Sydney, Australia
Melissa Power A , Kevin Dong A , Jennifer Walsh A , David A. Lewis A B C and Daniel Richardson
A D E
A Western Sydney Sexual Health Centre, 162 Marsden Street, Parramatta, NSW 2150, Australia.
B Marie Bashir Institute for Infectious Diseases and Biosecurity, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
C Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Westmead, NSW 2145, Australia.
D Sexual Health and HIV, Brighton and Sussex Medical School, Brighton, UK.
E Corresponding author. Email: daniel.richardson7@nhs.net
Sexual Health 18(4) 340-343 https://doi.org/10.1071/SH20189
Submitted: 13 October 2020 Accepted: 11 May 2021 Published: 16 July 2021
Abstract
Background: Eleven percent of people living with HIV in Australia remain unaware of their diagnosis, and there are missed opportunities for HIV testing in priority settings in New South Wales. HIV testing remains low outside of sexual health clinics with the exception of antenatal settings where HIV testing is routine. To understand why HIV testing rates are low, we sought to identify health worker-related barriers to HIV testing. Methods: We conducted an anonymous online survey to health workers in Western Sydney Local Health District (WSLHD) in September 2019. Tick-box, Likert scale responses were analysed using Chi-square and Kruskal–Wallis statistical tests, and free text responses were analysed with thematic analysis. Results: Three percent (n = 420) of WSLHD’s estimated 14 000 health workers responded. These included 317 clinicians (171 nurses, 65 doctors, 56 allied health professionals (AHPs), 25 midwives, and 103 health workers in non-clinical roles). Health workers were from a variety of in-patient/out-patient settings. Many health workers (291/420, 69%; 95%CI = 64.9–73.7%) were unaware that HIV testing is offered in their areas; doctors (82%) and midwives (80%) were more aware than nurses (23%) and AHPs (11%) (P < 0.0001). Doctors (Likert score = 3.62; 3.45/5) and midwives (2.84; 2.76) were significantly more comfortable discussing and confidently offering HIV testing than nurses (2.42; 1.81) or AHPs (1.83; 0.91) (P < 0.0001 for both). The top five barriers to HIV testing were (1) procedural knowledge, (2) identification of at-risk patients, (3) HIV knowledge, (4) positive result management, and (5) privacy concerns. Free text responses highlighted perceived stigma, testing/result responsibilities and resource challenges as barriers to HIV testing. Conclusions: Clinicians working in priority settings and with priority populations require more education and support to increase targeted HIV testing.
Keywords: HIV testing, Australia, HIV prevention, HIV knowledge, HIV stigma, health workers, clinicians, priority populations, high-risk populations, testing barriers.
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