By Christine Hughes
Estimates in Canada suggest that about 21% of people living with HIV do not know it. There are often many barriers to HIV testing including concerns about privacy and confidentiality, low perceived risk of infection, access to testing, and waiting about a week for test results. Current guidelines recommend that HIV testing should be part of routine care and that novel approaches are needed to make testing more available to people who may benefit from it. We know that earlier diagnosis and treatment of HIV leads to better patient outcomes, but also reduces the risk of transmission to others. Most people are tested for HIV by their family doctor or at STI clinics. Point of care (rapid) testing for HIV provides an opportunity to increase access to testing in non-traditional settings, such as community pharmacies. The test is performed using a finger prick blood sample and test results are available within minutes. Community pharmacists are accessible health care providers, especially in rural settings where health care services may be more limited.
The purpose of the APPROACH study is to determine whether HIV point of care testing in a community pharmacy setting is acceptable, feasible and effective in reaching individuals that may be a risk of HIV infection. This 6 month pilot study is funded by a grant from the Canadian Institute of Health Research and is being conducted in four community pharmacies (urban and rural) in Alberta and Newfoundland. The Alberta pharmacies are located in Edmonton (Community Members Pharmacy, 10611-101 Street) and Fort McMurray (Shoppers Drug Mart #327, Franklin Avenue). Testing will be available by appointment on weekdays. In order to be eligible for the pilot study, individuals need to be at least 18 years of age and have an active Alberta Health Care number.
As part of the study, pharmacists will provide pre and post-test counseling and administer the HIV test in a private counseling room at the pharmacy. The HIV test itself is highly accurate and looks for antibodies against the virus. If the test is reactive (positive), confirmatory testing is needed in order to diagnose HIV infection. In this case individuals will be provided with a form to have confirmatory testing done at a lab, and will be immediately linked to appropriate care and follow-up. In order to assess the study objectives, individuals enrolled in the study will be asked to complete a short pre-and post-test survey.
We hope to learn from this pilot study whether the model of HIV testing in a community pharmacy setting is acceptable to individuals requesting testing and whether it addresses some of the barriers to testing. We also want to learn whether HIV testing is feasible for pharmacists to incorporate into their work routine. If the pilot is successful we hope to expand to other pharmacies in Alberta and Newfoundland, as well as other parts of Canada.