摘要：The HIV epidemic is an ongoing public health problem fueled, in part, by undertesting for HIV. When HIV-infected people learn their status, many of them decrease risky behaviors and begin therapy to decrease viral load, both of which prevent ongoing spread of HIV in the community. Some physicians face barriers to testing their patients for HIV and would rather their patients ask them for the HIV test. A campaign prompting patients to ask their physicians about HIV testing could increase testing. A mobile health (mHealth) campaign would be a low-cost, accessible solution to activate patients to take greater control of their health, especially populations at risk for HIV. This campaign could achieve Healthy People 2020 objectives: improve patient–physician communication, improve HIV testing, and increase use of mHealth. World AIDS Day each December reminds us of the ongoing HIV epidemic in the United States and its disproportionate toll on racial and ethnic minority communities. HIV testing is an essential strategy to curb the ongoing epidemic. When people infected with HIV learn their status, many of them decrease risky behaviors to prevent spread to others 1 and begin antiretroviral therapy to decrease viral load, the main biological predictor of the ongoing spread of HIV in the community. 2 Despite national recommendations to make HIV testing routine for all adults, 3–6 HIV testing rates—particularly among the racial and ethnic communities hardest hit—remain low. 7 Patients want to be tested. 8 However, physicians face numerous HIV testing barriers, including physician discomfort with initiating HIV testing discussions, 9 physicians not realizing that patients expect HIV testing to be done, 8 time, 10,11 and competing clinical priorities. 11,12 A pioneering intervention to improve HIV testing in health care settings may be a patient-initiated approach. The push–pull capacity model offers a framework to guide a solution to improve patient-initiated HIV testing. 13,14 With a push–pull model, health information can be provided—or pushed—to many patients. This push creates a demand—or pull—for health services that address patient concerns. The ubiquity of cell phones and the pervasive use of text messaging provide an innovative platform for promoting an effective HIV testing campaign. Operationalizing the push–pull model through mobile health (mHealth) could be a novel approach to improving HIV testing in health care settings. This initiative would reduce demands on physicians, increase patients’ engagement in their own health, and address a significant ongoing public health problem. 15 Goals of Healthy People 2020 include eliminating health disparities and increasing the number of people who have been tested for HIV. 16
