We sit down with Christine Hughes, Vice Dean & Professor of the U of A’s Faculty of Pharmacy & pharmaceutical Sciences, to discuss the Who, What, When, Where, and Why of the APPROACH study, which is adding a new option for access to Rapid HIV Testing in Edmonton.
Who can access Rapid HIV Testing as part of this study?
Anyone who is 18 years of age and older with an active Alberta Health Care number who has not been previously diagnosed with HIV.
Who will be providing the testing? And have they received any special training to prepare them for Rapid HIV Testing delivery?
There is 1 pharmacist at Fort McMurray Shopper’s Drug Mart #327 and 3 pharmacists at Mint Health & Drugs – CMP in Edmonton who will be providing the testing. These pharmacists have been trained in providing pre- and post test counselling, administering the rapid test, and interpreting results. They have also been trained in providing information about the study and obtaining informed consent.
I’ve noticed that people are required to provide a PHN (Alberta Healthcare Number) unlike some of the outreach sites where people have historically been able to access Rapid HIV Testing. So, it appears that this is not anonymous or non-nominal testing (where someone doesn’t need to provide their real name). What kinds of identifying information will people be expected to provide in order to access Rapid HIV Testing for this study and what happens with that information?
The testing for this study is not anonymous. The pharmacists will be collecting name, date of birth, phone number, address and PHN number prior to administering the test. This information will be securely stored and will not be seen by or shared with the researchers.
Personal information collected will only be shared or used in the event of a reactive (or positive) test in order to fill out a confirmatory HIV testing lab requisition and to link the individual for follow-up care. For example, a public health nurse will be notified of the reactive rapid HIV test result and will be provided the individual’s name, date of birth, PHN and contact information in order to be able to follow-up, share the confirmatory HIV test results with the individual, and link them to HIV care, if necessary.
From previous community consultation, we know that Rapid HIV Testing is a very popular method of testing amongst GBQT men. But for those who don’t know what a Rapid HIV Test is, can you provide a description?
Rapid HIV testing requires a small amount of blood from a finger prick in order to perform the test. The blood sample is mixed with a solution and then poured into the test well membrane. It takes about a minute or two to perform the test itself and obtain the result. The test looks for antibodies to HIV. It is important to remember that this is a screening test, however it has a very high level of accuracy (>99% sensitivity and specificity).
The testing process includes pre-test counselling (e.g. what HIV is, how it is transmitted, discussion about the window period, and what the test results mean) as well as post test counselling which will be dependent on the test results. In the case of a non-reactive test result, post-test counselling includes ways to prevent HIV infection in future.
If someone was to test positive, what would the process look like from that point? And does the result of that Rapid HIV Test become attached in any way to that individual’s medical records?
The rapid HIV test results for this pilot will not be attached to the individual’s medical records. If someone was to have a reactive rapid HIV test result, a confirmatory test is required to confirm the HIV diagnosis. This is the same process that is used when doing a standard HIV antibody screening test as false positives can happen (although it is not common).
The pharmacist will provide the individual with a lab requisition to have the confirmatory HIV test done as soon as possible. The pharmacist will also be contacting a public health nurse that will follow up on the confirmatory tests results and communicate this information to the individual. The public health nurse will also be able to link the individual to HIV care.
The When & Where?
If someone reads this interview and wants to go get tested, how do they go about that?
Here in Edmonton, testing will be done at Mint Health & Drugs CMP (10611-101 Street, Phone 780-757-1030). Testing will be available by appointment on Tuesdays, Wednesdays, and Thursdays (daytime hours). The pilot study will run for 6 months (approximately mid-March to mid-September).
Testing will also be available by appointment Monday to Friday (daytime hours) at Shoppers Drug Mart in Fort McMurray (8600 Franklin Ave, Unit 500, River City Centre, Phone (780) 743-1251).
Firstly, why is it so important that people are tested and aware of their HIV status?
Testing is important so that people know their HIV status and can get started on treatment as early as possible if they are infected with HIV. HIV treatment over the past decade or so has improved substantially and most regimens for people starting treatment today involve 1 pill once daily and are very well tolerated.
We know the earlier people start on treatment, the better their health outcomes. If treatment is started early, life expectancy of people living with HIV is very close to those individuals who do not have HIV infection. We also know that the risk of transmitting the virus to others is extremely low if people are on HIV treatment and have a suppressed viral load. We don’t have a cure yet for HIV but it is possible to prevent transmission, which starts with knowing your status.
So, what is the point of offering Rapid HIV Testing out of a pharmacy for six months? What does the study hope to determine? And what potential impacts could its findings have on how the community is able to access Rapid HIV Testing in the future?
We know from previous research that there are a lot of barriers to testing, such as access to testing, not being comfortable going to a family doctor or an STI clinic to request a test, or sometimes not being offered an HIV test by a health provider due to low perceived risk of infection. Some people also do not want to wait about a week to get their test results. While we can’t address all of these barriers with this particular study, we hope to learn more about people’s experiences with rapid HIV testing in a community pharmacy setting and also more about the types of individuals that are accessing testing.
We also want to know if this is feasible for pharmacists to incorporate into their work routine. Current testing guidelines recommend that HIV testing should not be targeted only for “higher risk” groups and that novel approaches are needed to reach individuals who may not be aware of their infection. After the pilot is completed, we hope to have funding to expand the study (and rapid HIV testing) further to other community pharmacy sites in Alberta, Newfoundland, and other parts of Canada. Hopefully this will also lead to expanding rapid HIV testing in other community based settings as well.