Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates

PLoS One. 2019 Jul 2;14(7):e0218380. doi: 10.1371/journal.pone.0218380. eCollection 2019.

Abstract

Background: Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed.

Methods: A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer.

Results: A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01-1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77-0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17-0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01-5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04-2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02-1.42; p = 0.036).

Conclusions: This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.

Publication types

  • Clinical Trial
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Delayed Diagnosis / prevention & control*
  • Education, Continuing*
  • Female
  • HIV Infections* / diagnosis
  • HIV Infections* / epidemiology
  • HIV Infections* / therapy
  • Health Personnel / education*
  • Humans
  • Male
  • Mass Screening*
  • Middle Aged
  • Primary Health Care*

Associated data

  • figshare/10.6084/m9.figshare.8160068.v1

Grants and funding

This study was supported by two competitive Grants: GILEAD FELLOWSHIP 2015, 2016/0056 and the Ministerio de Sanidad, Seguridad Social e Igualdad Projects codes: PI16/00551; EC11-144, co-financed by the European Development Regional Fund ‘‘A way to achieve Europe’’ (ERDF) and partially funded by the RD12/0017/0017 project as part of the Plan Nacional R + D + I and cofinanced by ISCIII- Subdirección General de Evaluación y el Fondo Europeo de Desarrollo Regional (FEDER), and also partially supported by unrestrictional grants from Janssen Cilag supporting FOCO project developed by the Spanish AIDS Interdisciplinary Society (SEISIDA), VIIF and Gilead supporting DRIVE 01, 02 and DRIVE 03 through IRYCIS. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.