Development and testing of an HIV-risk screening instrument for use in health care settings

  • Barbara Gerbert
    Address correspondence to: Barbara Gerbert, PhD, Professor and Chair, Division of Behavioral Sciences, University of California, San Francisco, 601 Montgomery, Suite 810, San Francisco, California 94111
    Division of Behavioral Sciences, School of Dentistry (Gerbert, Bronstone), University of California, San Francisco, California, USA, 94111
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  • Amy Bronstone
    Division of Behavioral Sciences, School of Dentistry (Gerbert, Bronstone), University of California, San Francisco, California, USA, 94111
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  • Stephen McPhee
    Division of General Internal Medicine, Department of Medicine (McPhee, Pantilat), University of California, San Francisco, California, USA, 94111
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  • Steven Pantilat
    Division of General Internal Medicine, Department of Medicine (McPhee, Pantilat), University of California, San Francisco, California, USA, 94111

    Program in Medical Ethics, Department of Medicine (Pantilat), University of California, San Francisco, California, USA, 94111
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  • Michael Allerton
    Kaiser Permanente Medical Group, Inc., Kaiser Permanente Medical Center (Allerton), Oakland, California 94612, USA
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      Objective: To develop and test a brief, reliable, and valid HIV-risk screening instrument for use in primary health care settings.
      Design: A two-phase study: (1) developing a self-administered HIV-risk screening instrument, and (2) testing it with a primary care population, including testing the effect of confidentiality on disclosure of HIV-risk behaviors.
      Setting: Phase 1: 3 types of sites (a blood donor center, a methadone clinic, and 2 STD clinics) representing low and high HIV-seroprevalence rates. Phase 2: 4 primary care sites.
      Participants: Phase 1: 293 consecutively recruited participants. Phase 2: 459 randomly recruited primary care patients.
      Main Outcome Measure: Phase 1: comparison of the responses of participants from low and high HIV-seroprevalence sites. Phase 2: primary care patients’ rates of disclosure of HIV-risk behaviors and ratings of acceptability.
      Results: Phase 1: through examining item-confirmation rates, item-total correlations, and comparison of responses from low and high HIV-seroprevalence sites, we developed a final 10-item HIV-risk Screening Instrument (HSI) with an internal consistency coefficient of .73. Phase 2: 76% of primary care patients disclosed at least 1 risky behavior and 52% disclosed 2 or more risky behaviors. Patients were willing to disclose HIV-risk behaviors even knowing that their physician would see this information. Ninety-five percent of our patient participants were comfortable with the questions on the HSI, 78% felt it was important that their doctor know their answers, and 52% wished to discuss their answers with their physician.
      Conclusion: Our brief, self-administered HSI is a reliable and valid measure. The HSI can be used in health care settings to identify individuals at risk for HIV and to initiate HIV testing, early care, and risk-reduction counseling, necessary goals for effective HIV prevention efforts.


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