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Halifax Researchers Find High Acceptability for Rapid HIV Testing

May 28, 2013

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According to the Public Health Agency of Canada, there are about 71,000 HIV-positive people in Canada, 26% of whom do not know their HIV status. It is in this context that expanding opportunities for offering HIV testing should be seen as helpful because they can do the following:

  • help uncover undiagnosed HIV infections
  • reinforce education about safer sex and substance-using behaviours during the counselling that accompanies HIV testing
  • inform newly diagnosed HIV-positive people about the benefits of early treatment and offer avenues for them to explore this

This latter point is important for at least the following reasons:

  • Early initiation of potent combination HIV therapy (commonly called ART or HAART) helps to preserve the immune system and places the HIV-positive person on a path to better health. The impact of ART is so profound that a young adult who is diagnosed with HIV today in Canada and similar countries, who has minimal or no co-existing health conditions and who takes ART every day exactly as directed, is expected to live for several decades.
  • The other benefit of early initiation of ART is that it can greatly reduce the amount of HIV in the blood (viral load) and genital fluids. This reduces the sexual infectiousness of ART users. If many HIV-positive people take ART, this has the potential to reduce the future spread of HIV in a large city or region.

Using ART to help improve a person's health and to reduce his or her sexual infectiousness is called Treatment as Prevention (TasP). In Canada, HIV testing and TasP are being offered in British Columbia, where research suggests that this strategy is generally working by reducing the rate of new HIV infections, particularly among injection drug users and heterosexual people. A key part of the BC initiative is the offer of an HIV test.


Barriers to HIV Testing

Researchers at Dalhousie University in Halifax, Nova Scotia, have been conducting work on HIV testing. In their latest project, they focussed on the views of users of a sexual health clinic on rapid HIV testing. As part of its work, the Dalhousie team of researchers reviewed scientific publications about HIV testing and reported that those studies have found that some people at high risk for HIV infection do not get tested because of at least the following reasons:

  • fear of the testing process
  • anxiety about receiving test results
  • lack of access to testing
  • stigma associated with HIV


About Rapid Point of Care HIV Testing

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In some parts of Canada, particularly in large urban centres, rapid point of care (POC) HIV testing is available in select locations. This type of test requires a few drops of blood taken from the finger and can be done in almost any community setting. The usual protocol involves counselling clients about the test before the test is done and counselling them about behaviours that commonly lead to HIV transmission. The test result is usually available in a couple of minutes. If it is negative, the client receives the result and further counselling. If the test result is reactive (this is considered a preliminary positive test result), the client receives the result and post-test counselling, including referrals to healthcare providers. After obtaining informed consent, the counsellor can then draw blood for a confirmatory test. Although the rapid POC test has a high level of accuracy (more than 99%), reactive test results need to be confirmed by a central laboratory before someone can be conclusively diagnosed as HIV positive. This confirmatory test can take one to two weeks depending on the laboratory -- an anxious time for many people.

The advantages of rapid POC testing include the following:

  • it can be done in community settings
  • only a few drops of blood are required
  • clients can have the same person provide counselling both before and after the test
  • the test result is available quickly


Favoured by People at High Risk for HIV

As part of their review of scientific publications on rapid POC testing, the Halifax researchers found that "even at sites where rapid POC testing is not the overall preferred method of testing, it tends to be favoured by high-risk clients, such as men who have sex with men and injection drug users."


Halifax Research -- Attitudes Towards Rapid POC Testing

The research team at Dalhousie University conducted a study of attitudes toward rapid POC testing among people who were seeking anonymous HIV testing. The team found that rapid POC testing was "highly acceptable" to this population. The team's report, published in the journal Sexual Health, is important reading for clinics that specialize in screening for sexually transmitted infections (STIs), community-based health centres, and health policy planners, particularly in the Atlantic provinces of Canada. Rapid POC HIV testing can be an important tool to reach busy people and bypass some of the barriers associated with standard HIV testing.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication CATIE News. Visit CATIE's Web site to find out more about their activities, publications and services.
 

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