Why don’t physicians talk to their patients about recommended HIV screening tests?
“We clinicians mean well, but it’s complicated,” says Monisha Arya, M.D., M.P.H, a clinician and health communications researcher at Baylor College of Medicine.
Arya and her team have been interested in why physicians don’t offer HIV testing to all of their patients, despite national and professional society recommendations.
Since 2006, the Centers for Disease Control and Prevention have recommended that all adults be tested for HIV if they live in a high HIV prevalence city, such as Houston. The CDC made these recommendations because the HIV epidemic was continuing unabated despite the availability of life-saving drugs.
Many people infected with HIV initially have no symptoms, so they do not get tested and remain unaware of their HIV status. These unaware people can’t get life-saving antiretroviral therapies and unknowingly pass HIV to others.
Antiretroviral therapy can save their lives and, if taken regularly, can also reduce the chance of transmission to others by more than 90 percent. Yet studies have found that many patients diagnosed with HIV were never tested for HIV during multiple prior physician visits.
When an HIV test was finally done for these patients, many were already at or near a life-threatening AIDS diagnosis and possibly had spread HIV to others by that time. Why weren’t these physicians following the national recommendations?
Arya’s team discovered a patient-physician HIV testing communication disconnect.
Her team surveyed 175 primary care physicians in Houston. One-third were not testing all of their patients for HIV. These physicians thought their patients would be uncomfortable discussing HIV, would be offended if the HIV test were offered or would refuse the test.
In fact, 70 percent would rather that their patients ask for the HIV test. However, research by Arya’s team and others found that patients want their physicians to offer the HIV test and, in fact, expect their physician to test them.
In 2015, Arya’s team began developing media campaigns to help address this HIV testing communication disconnect. A 1.5-minute video encouraging physicians to offer HIV testing to all of their patients was created in collaboration with Rice University undergraduates in Professor Kirsten Ostherr’s medical media arts lab.
The video addresses eight physician barriers to testing — including informing physicians of the CDC’s HIV testing recommendations and providing data showing that 81 percent of their patients would say “yes” to an HIV test if their physician offered it.
Because many physicians indicated they want patients to just ask for the HIV test, Arya’s team is also working on an innovative mobile health campaign that will text patients immediately before an appointment to remind them that their HIV test is due and to encourage them to discuss it with their physician.
Traditional push-pull models push consumers to create demand for products or services. Arya’s team is adapting this model, developing media campaigns that will “push” patients or physicians to “pull” the other into a discussion for a recommended health service.
“If we can develop innovative campaigns to encourage both patients and their physicians to talk to each other about HIV testing, these campaigns could be used as a model to improve communication for other disease prevention initiatives such as missed cancer screenings or missed immunizations,” Arya said.
Arya hopes her work will be a helpful nudge for busy physicians faced with a barrage of health recommendations and also will educate patients and engage them in the important role of advocating for their own health.
This article originally appeared in the December 2015 newsletter of Rice University’s Baker Institute for Public Policy-Baylor College of Medicine Joint Program in Health Policy Research.