University of California San Francisco researchers have developed and tested a questionnaire designed to help health care providers identify patients at risk of contracting HIV and target prevention counseling at patients engaging in risky behavior.
Having such a tool is an important step in making the prevention and treatment of HIV a more common topic of discussion between health care providers and patients, researchers said.
It is essential, they said, that health care providers more aggressively act to prevent the spread of HIV and AIDS, which is the third leading cause of death of 25 to 44-year-old men and women.
"Doctors don't ask patients the relevant questions and patients don't volunteer the information," said UCSF psychologist Barbara Gerbert, PhD, professor and chair of UCSF's Behavioral Sciences Division in the School of Dentistry. "Having this instrument will help physicians bring up the topic."
Gerbert led the new UCSF study, published in the August edition of the American Journal of Preventive Medicine, that shows the ten-item questionnaire is an effective tool in identifying patients at-risk for contracting HIV, and that the majority of patients who took the test were willing to discuss the results with their health care provider.
The questionnaire asks patients whether they engage in behavior that could put them at risk for contracting HIV. The ten questions focus on a range of behavior known to put people at risk of the disease, from condom use and having anal sex to injecting drugs with needles.
Health care providers can determine risk based on patients' answers as they relate to other factors, such as the overall risk of the population where patients live. For example, having sex with two or more partners over a ten-year period may pose little risk to populations in communities where the overall HIV rate is low, Gerbert said. However, that same behavior may put people in high-risk populations in greater danger of contracting the disease, she said.
Though physicians and other health care workers periodically receive training in how to discuss HIV with patients, there are still numerous barriers preventing those discussions, Gerbert said. Doctors, or their patients, may be uncomfortable or embarrassed discussing the subject, she said. Health care providers' assumptions about patients, and who may or may not be at-risk of HIV, may also act as barriers.
The UCSF questionnaire, however, eliminates some of that awkwardness because patients answer the questions on paper, rather than face-to-face with their doctors, Gerbert said. The questionnaire is designed for patients to fill out as part of their standard health history, she said.
In addition, the new UCSF questionnaire is the first of its kind to be tested, Gerbert said.
The first goal of the two-part study was to develop a reliable and easy-to-use instrument to screen patients for risk of contracting HIV. Initially, UCSF researchers developed an 18-item questionnaire, which was administered to a total of 300 blood bank donors, patients at clinics for sexually transmitted diseases and attendees at a methadone clinic.
That questionnaire was eventually pared down to ten items. The resulting HIV risk screening instrument had a Kuder-Richardson coefficient of .73, which means that patients answered the questionnaire items in a fairly consistent manner. The items on the 10-item questionnaire effectively distinguished people in high-risk and low-risk groups, researchers said.
The second goal of the study was to determine whether primary care patients would answer the questionnaire honestly knowing that their doctor would see it. The study did that by asking 459 primary care patients in the San Francisco Bay Area to answer the items on the questionnaire, with half knowing their doctor would see the results and half knowing they would be kept confidential. There was little difference in the answers from patients in the two groups, meaning patients were willing to disclose most risky behavior even when the information would be shared with their doctor, researchers said.
Co-researchers on the study are: Amy Bronstone, PhD, UCSF Division of Behavioral Sciences; Stephen McPhee, MD, UCSF Department of Medicine; Steven Pantilat, MD, UCSF Department of Medicine; and Michael Allerton, MS, Kaiser Permanente Medical Center, Oakland.
The study was funded by the National Institute of Mental Health.