Barriers and facilitators to HIV testing in people age 50 and above: a systematic review

Background: Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people =50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged =50 years. Methods: A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. Findings: 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Interpretation: Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions.