Clinician Barriers and Facilitators to Routine HIV Testing: A Systematic Review of the Literature.

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.