Exploring alternative methods to HIV testing to meet the UNAIDS 90-90-90 targets

On April 26, 2018, the National HIV/AIDS Laboratories, National Microbiology Laboratory – Public Health Agency of Canada (PHAC) collaborated with REACH 2.0 and the National Collaborating Centre for Infectious Diseases (NCCID) to bring together over 50 participants from across Canada to reflect on methods for HIV testing. The session featured four testing technologies that provide alternatives to the standard approach to HIV testing. These approaches have the potential to expand HIV testing options in Canada when scaled up and implemented in a sustainable manner:

  • Self-testing: Performing an HIV test on oneself, either alone or in the presence of a health or service provider.
  • Pharmacy-delivered point-of-care testing: Training pharmacists to test for and deliver HIV results to clients.
  • Multiplex testing: Screening for multiple infections such as HIV, hepatitis B and C, as well as syphilis
  • Dried blood spot (DBS) testing: Collecting blood samples on filter paper within a community setting – once the sample has dried, it can be sent by regular mail to a laboratory for further testing.

Over the course of the presentations and the discussions that ensued, we identified three salient themes:

  1. Stigma, confidentiality and the ways in which testing is advertised.

Participants noted that positive messaging was key to encouraging testing and reducing HIV-associated myths around transmission. Digital strategies could be another way to increase testing while respecting privacy. Creating supportive and culturally safe environments were also discussed – specifically, the importance of relationship-building and establishing trust. Peers are a bridge between communities and health care providers.

  1. Local community engagement and local partnerships.

Community buy-in and strong leadership are essential for successful implementation and sustainability of testing initiatives. This means investing time to engage with policy-makers, community-based organizations, practitioners and government to establish appropriate mechanisms for linkage to care and treatment. From a program science perspective, participants urged researchers to gather data that assessed the quality of the relationship between clients and providers in order to truly evaluate any testing initiatives.

  1. Facilitators for the implementation of new testing strategies.

Supportive, culturally-appropriate and culturally-safe relationships were major components of success. Further, upstream approaches that engage stakeholders are fundamental to improving the cascade of care – testing is but the first step towards a holistic approach to integrated health care. Lastly, work closely with peers to engage communities and improve navigation through complex health systems.

A final point worth noting is that, while the implementation of new testing approaches is timely and needed, we should also look to improving our current “standard” approach to HIV testing. What do you think?

Thank you to everyone who participated in the session, to the event organizers and to each of the panelists. An extra big thank you to Dr. John Kim from the National HIV/AIDS Laboratory for pitching the idea for this event, and to Geneviève Boily-Larouche from the National Collaborating Centre for Infectious Diseases (NCCID) for compiling the session evaluations and preparing an excellent summary of the discussions. This report will be available soon!

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