Barriers and facilitators to enhancing HIV testing in publicly funded primary care clinics: findings from San Francisco.

Although the City of San Francisco hosts a number of community-based HIV test sites, about 2,500 infected individuals are unaware of their serostatus. Primary medical care settings may provide improved access to HIV testing, particularly if testing programs are well matched to the setting where they are implemented. To plan for expanding testing in these settings, we assessed trends in testing in publicly supported clinics and conducted qualitative interviews to assess current testing practices, linkage to care and partner services practices, and barriers to implementing and/or expanding HIV testing. We presented the results to stakeholders and asked them to help develop recommendations to expand testing and linkage to care. Since 2007, testing has increased in primary care settings although a gap in access remains. Primary care providers endorsed the concept of routine HIV testing but raised concerns and recommended a staged approach to expanding testing. Stakeholders recommended that the city's public health department provide enhanced capacity building assistance and support a new linkage to care and partner services team. This study holds lessons for other jurisdictions seeking to expand HIV testing in primary care.