If you're looking for resources to inform an evidence-based decision, guidelines are a key tool to turn to. Evidence-based guidelines provide recommendations based on a review of the research literature. Recommendations can also be developed from the consensus of experts in the field and the experience of practice-based evidence.
Guidelines are issued by a variety of sources including governments and expert groups at the local, national and international levels. This article highlights HIV testing and prevention guidelines developed in Canada. This article is the first of three articles that will appear in Prevention in Focus in 2017 and 2018 on Canadian HIV and hepatitis C guidelines. While some guidelines are relevant nationally, others may have been developed to respond to a local context, but may still be informative for other regions.
Testing
Testing guidelines address a range of factors to consider when delivering HIV testing. Recommendations commonly cover screening people for HIV testing, testing in specific populations, testing frequency and test counselling. Testing guidelines can also address legal and ethical issues such as confidentiality and disclosure, and technical issues such as test types and technologies.
In Canada, the Public Health Agency of Canada has developed a guide with general recommendations for HIV testing that can be taken into consideration alongside any existing local or specialized practices. A number of provinces have also developed testing guidelines that reflect approaches and procedures specific to the province.
Human immunodeficiency virus: screening and testing guide -- Public Health Agency of Canada
HIV testing guidelines for the province of British Columbia -- British Columbia Office of the Provincial Health Officer
Guidelines for HIV testing and counselling -- Ontario Ministry of Health and Long-Term Care
Ontario HIV testing frequency guidelines: guidance for counselors and health professionals -- Ontario Ministry of Health and Long-Term Care
Guide québécois de dépistage des infections transmissibles sexuellement et par le sang -- Ministry of Health and Social Services of Quebec
Saskatchewan HIV testing policy -- Saskatchewan HIV Provincial Leadership Team
Post-Exposure Prophylaxis (PEP)
Post-exposure prophylaxis guidelines can cover the use of PEP after an occupational exposure, non-occupational exposure, or both. They generally address infections, such as HIV, that may be transmitted by blood or other body fluids.
The guidelines listed here have been developed by provincial and territorial governments. They provide guidance on assessing whether a potential exposure may require PEP, testing of the source or recipient of the exposure, and the drug regimens and procedures to use when administering PEP. The guidelines can also provide information on local resources or copies of specific forms used in the province or territory.
A group of clinicians, researchers and community members are developing national guidelines for the prescribing of PEP and PrEP (pre-exposure prohylaxis) in Canada. These guidelines will provide evidence-informed guidance on how to assess patient eligibility for PEP and how to correctly prescribe it. The guidelines are expected to be released in early 2017.
Alberta guidelines for non-occupational, occupational and Mandatory Testing and Disclosure Act post-exposure management and prophylaxis: HIV, hepatitis B, hepatitis C and sexually transmitted infections -- Alberta Health
Blood and body fluid exposure management -- Yukon Health and Social Services
Guidelines for the management of exposures to blood and body fluids -- Government of Saskatchewan
Guidelines for the management of percutaneous or sexual exposure to bloodborne pathogens -- Department of Health and Wellness, Prince Edward Island
Guide pour la prophylaxie après une exposition au VIH, au VHB et au VHC dans un contexte non professionnel : Résumé -- Ministry of Health and Social Services of Quebec
Guide pour la prophylaxie postexposition (PPE) à des liquides biologiques dans le contexte du travail -- Ministry of Health and Social Services of Quebec
Integrated post-exposure protocol for HIV, HBV and HCV: guidelines for managing exposures to blood and body fluids -- Manitoba Health, Seniors and Active Living
Pre-Exposure Prophylaxis (PrEP)
The daily use of the antiretroviral drug Truvada, in combination with safer sex practices, for reducing the risk of the sexual transmission of HIV was approved in Canada in February 2016. Guidelines help inform the delivery of PrEP in clinical settings. PrEP guidelines can include recommendations on screening people for PrEP use, the prescription of PrEP, monitoring while on PrEP, and stopping PrEP.
A group of clinicians, researchers and community members are developing national guidelines for the prescribing of PrEP and PEP (post-exposure prophylaxis) in Canada. These guidelines will provide evidence-informed guidance on how to assess patient eligibility for PrEP and how to correctly prescribe it. The guidelines are expected to be released in early 2017.
Guidance for the use of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia -- British Columbia Centre for Excellence
Harm Reduction
Harm reduction programs help reduce the transmission of HIV and hepatitis C among people who use drugs. This resource provides guidance for harm reduction programs by examining the context and effectiveness of practices that facilitate safer drug use and offering recommendations for the delivery of harm reduction services. Topics covered include the distribution of safer drug use equipment, education and overdose prevention. Related concerns are also addressed, such as health and support service delivery and referrals for people who use drugs.
Best practice recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms -- Working Group on Best Practice for Harm Reduction Programs in Canada
Looking for additional guidelines? Check out Programming guides and tools in the Strengthening Programming section of the CATIE website for more Canadian and international guidelines on HIV, hepatitis C and related topics. And stay tuned for future Prevention in Focus articles on guidelines for HIV care and treatment and hepatitis C.
Erica Lee is the Information and Evaluation Specialist at CATIE. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).