Tag Archives: Treatment

Expanding access to HIV point of care testing through community pharmacies: the APPROACH study

By Christine Hughes

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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.

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World AIDS Day 2014

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What happened on World AIDS Day?

By Ngozi Chinwe Mbonu

Since HIV was discovered in 1981, we have come a long way in understanding, treating, and preventing the disease. However, what many do not understand is that despite the fact that we have made progress in the challenges involved in managing HIV, of finding pre-exposure prophylaxis, post-exposure prophylaxis, and other medications to combat the virus, HIV stigma and discrimination is still present, among other challenges. Worldwide, persons living with HIV are still vulnerable in their families, communities, and workplace. The most affected people include women, transgender, men who have sex with men, people who inject drugs, and minorities.

 

On World AIDS day 2014, many events were held and announcements were made around the world. Notable among them was the 2014 Paris Declaration that included commitments to focus on the communities most affected by HIV, to mobilize resources for the better integration of public health and development, to build and accelerate urban HIV strategies, and to use the AIDS response as a catalyst for positive social transformation. Mayors from around the world came together in Paris to sign a declaration to end the AIDS epidemic in their cities. In signing the 2014 Paris Declaration, the Mayors commit to putting cities on the fast-track to ending AIDS through a set of commitments include achieving the UNAIDS 90-90-90 targets. UNAIDS target of 90-90-90 by 2020 means that 90 percent of people living with HIV know their status, 90 percent of people who know their status receive treatment, and 90 percent of people on HIV treatment have a suppressed viral load so their immune system remains strong and they are no longer infectious. The 90-90-90 target is expected to be boosted to 95-95-95 by 2030. On World AIDS day 2014, UNAIDS aim of closing the gap means closing the HIV testing gap, treatment gap, and access to medicine including children. At the moment, 19 million people are unaware of their HIV-positive status, 35 million people living with HIV do not have access to life-saving medicine and only 24% of children have access today. Fortunately on World AIDS day, the Medicine Patent Pool and U.S. President’s Emergency Plan for AIDS Relief in partnership with the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund) announced an important milestone aimed at allowing generic manufacturers access to formulation of HIV medication for children. This means that WHO first line treatment for children under 3 is no longer patented. All of this gives us hope and encouragement to continue to work on our goals.

 

On a national scale, an estimated 71,300 Canadians were living with HIV, and an estimated 3,175 new HIV infections occurred in 2011. This number is simply too high, and we must work together to ensure that we recommit ourselves to protecting the rights of persons living with HIV, and prevent further new infection in Canada. Western University marked World AIDS day with announcement of a new facility which will combine imaging technology with real time non-invasive interaction between the virus and the host. This facility is the first of it’s kind in Canada, and will provide new opportunities to research how to treat various infections diseases. This fantastic facility is scheduled to be completed by fall 2015.

 

Although we have made important advancements in technology and medications for managing HIV, stigma and discrimination is still a major driver of HIV infection which affects access. Zero new infection is achievable as long as we look at the underlying factors that allow infection to take place in the first place. We know that HIV is not passed on through spitting, biting or sharing utensils. We know that currently there is pre exposure prophylaxis for people to take even before becoming infected. We know that there is post exposure prophylaxis for people who are exposed to HIV. We know that vertical transmission can be prevented if HIV medication is taken and there is proper care during pregnancy and delivery. We all have a role to play in this. This is the time to make sure we continue to move forward on the progress made so far.

 

Now that we have marked the World AIDS day 2014, let us all continue the good work we are doing that has allowed us to get this far as global community to support persons living with HIV and AIDS and to ensure our goal of zero new HIV infection, zero stigma and discrimination, and zero AIDS related death is achieved.

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