Opportunities for improved indicator-based HIV testing in the hospital setting: a structural equation model analysis

ABSTRACT

Indicator condition (IC)-guided HIV testing, i.e., testing when diagnosing a condition associated with HIV, is a feasible and cost-effective testing strategy to identify undiagnosed individuals. Assessing determinants for IC-guided testing may identify opportunities for improvement. A survey study based on the Theory of Planned Behaviour (TPB) was conducted among 163 hospital physicians from five specialties in Amsterdam, the Netherlands. Structural equation models were used to determine the association between the TPB domains (i.e., attitude, belief, norms, self-efficacy and behavioural control) and (1) the intention to test as a mediator for HIV testing behaviour (intentional model) and (2) actual HIV testing behaviour (direct model). Both models accounted for the effect of guideline recommendations. Behaviour scored lower than intention on a five-point scale (mean score of 2.8, SD = 1.6 versus 3.8, SD = 1.1; p<0.0001). The direct model had a better fit than the intentional model based on fit statistics. Discrepancies between the determinants most important for intention versus those for behaviour led to the following recommendations: interventions to improve IC-guided testing in hospitals should primarily focus on implementation of guideline recommendations, followed by improving physicians’ attitude towards IC-guided HIV testing and self-efficacy, as these were the most important correlates of actual HIV testing behaviour.

KEYWORDS:

• HIV testing
• theory of planned behaviour
• behavioural science
• healthcare provider
• indicator condition
• provider-initiated testing

Acknowledgements

We thank all physicians who participated in this study. We thank all coordinating physicians from the study hospitals Amsterdam UMC location AMC, Amsterdam UMC location VUmc, BovenIJ ziekenhuis Amsterdam, Flevoziekenhuis Almere and Onze Lieve Vrouwe Gasthuis Amsterdam: Prof. Dr. S. E. Geerlings, Dr. K. Sigaloff, Dr. N. Bokhizzou, Dr. J. Branger and Prof. Dr. K. Brinkman. We further acknowledge all members of the H-TEAM Consortium: T. van Benthem, D. Bons, G. J. de Bree, P. Brokx, U. Davidovich, F. Deug, S. E. Geerlings, M. Heidenrijk, E. Hoornenborg, M. Prins, P. Reiss, A. van Sighem, M. van der Valk, J. de Wit, W. Zuilhof. H-TEAM Project Management: N. Schat, D. Smith. H-TEAM additional collaborators: M. van Agtmael, J. Ananworanich, D. Van de Beek, G. E. L. van den Berk, D. Bezemer, A. van Bijnen, J. P. Bil, W. L. Blok, S. Bogers, M. Bomers, A. Boyd, W. Brokking, D. Burger, K. Brinkman, N. Brinkman, M. de Bruin, S. Bruisten, L. Coyer, R. van Crevel, M. Dijkstra, Y. T. van Duijnhoven, A. van Eeden, L. Elsenburg, M. A. M. van den Elshout, E. Ersan, P. E. V. Felipa, T. B. H. Geijtenbeek, J. van Gool, A. Goorhuis, M. Groot, C. A. Hankins, A. Heijnen, M. M. J. Hillebregt, M. Hommenga, J. W. Hovius, Y. Janssen, K. de Jong, V. Jongen, N. A. Kootstra, R. A. Koup, F. P. Kroon, T. J. W. van de Laar, F. Lauw, M. M. van Leeuwen, K. Lettinga, I. Linde, D. S. E. Loomans, I. M. van der Lubben, J. T. van der Meer, T. Mouhebati, B. J. Mulder, J. Mulder, F. J. Nellen, A. Nijsters, H. Nobel, E. L. M. Op de Coul, E. Peters, I. S. Peters, T. van der Poll, O. Ratmann, C. Rokx, M. F. Schim van der Loeff, W. E. M. Schouten, J. Schouten, J. Veenstra, A. Verbon, F. Verdult, J. de Vocht, H. J. de Vries, S. Vrouenraets, M. van Vugt, W. J. Wiersinga, F. W. Wit, L. R. Woittiez, S. Zaheri, P. Zantkuijl, M.C. van Zelm, A. Żakowicz, H. M. L. Zimmermann.

Disclosure statement

Dr. Bogers has nothing to disclose. Dr. Boyd reports grants or contracts: ANRS, ZonMW and Participation on the Data Safety Monitoring Board or Advisory Board: Amsterdam University Medical Centers, Inserm. Dr. Schim van der Loeff has nothing to disclose. Dr. Davidovich has nothing to disclose. Dr. Geerlings has nothing to disclose.

Data availability statement

The data that support the findings of this study are available from the corresponding author, S. B., upon reasonable request.

Additional information

Funding

This project is funded by Aidsfonds [grant number: P-42702] and the H-TEAM initiative.