PAN is pleased to participate in the National HIV&STBBI Testing Working Group, an initiative described below. This write-up was produced by our colleague Alex Musten from the CIHR Centre for REACH in HIV/AIDS and originally posted to national REACH 2.0 blog. If you have questions about this post or about the Working Group, please contact Heather Holroyd at [email protected]. Learn more about REACH on their site.
The National HIV&STBBI Testing Working Group meets monthly via teleconference to discuss testing devices, innovative approaches, and other issues related to increasing access to testing and care within Canada. Testing Talking Points provides a brief overview and investigation of the major themes that are discussed on these calls to encourage a broader conversation about issues surrounding HIV&STBBI testing in Canada.
Testing rates remain low in some regions and within some populations for a few reasons which include but are not limited to (1) Lack of availability of testing, (2) Provincial restrictions on who can deliver an HIV test (3) Stigma that prevent individuals from seeking testing and care.
Of the nearly 40 rapid HIV testing devices, including multiplex devices[1], that are available globally, bioLytical’s INSTI rapid HIV-1/HIV-2 rapid test remains the only one that has been approved by Health Canada[2]. Discussion of this lack of choice for testing in Canada is often coupled with reflection upon the difficult approval process for new devices within Health Canada, as well as the lack of willingness on behalf of industry to file for approval due to a lack of return on investment and market uncertainty.
It has been suggested that routine offer of HIV testing may be the key to encouraging companies to file for approval with Health Canada. The rationale being that routine testing would increase the number of tests being delivered, and create a market that would support a positive return on investment for companies.
2006, the US CDC put forth a revised recommendation that encouraged routine voluntary HIV screening as a normal part of medical practice[3] and there are currently seven approved rapid HIV testing devices including one multiplex and a home-test[4]
In Canada, PHAC released an HIV Screening Testing Guide in 2013 that included recommendations such as making the offer of an HIV test part of periodic routine medical care, ensuring that HIV testing remain voluntary and based on informed consent as well as integrate HIV testing services[5]. However, currently only British Columbia and Saskatchewan, and more recently Manitoba and Ontario are currently implementing this recommendation[6]. Of those two, British Columbia remains the only one that has developed and implemented a comprehensive plan that puts these recommendations into practice, and it is worth noting that these activities occurred before PHAC’s recommendations[7].
There exists a number of reasons why provinces are unable or unwilling to take on these recommendations, and addressing these barriers requires the active engagement of stakeholders in each region to accurately address each one that is specific to their region. The experience in the US indicates with routine, voluntary HIV testing can increase the number of diagnoses made, demonstrate a market need that will make it more appealing for companies to file for approval and thus potentially increase the number of devices made available in Canada as well as increase access to more varied options for HIV testing for Canadians.
Recommended Reading on Routine Testing
References
[1] WHO HIV Assays Laboratory Performance and other Operational Characteristics Report 18
[3] Revised Recommendations for HIV Testing of Adults, Adolescents, and Pregnant Women in Health-care Settings
[4] Complete List of Donor Screening Assays for Infectious Agenda and HIV Diagnostic Assays
[5] New PHAC testing guide includes recommendations to promote HIV testing during routine medical care.
[6] The state of HIV testing in Canada: A systematic review.
[7] Shifting the Paradigm: The History of the Vancouver Stop HIV/AIDS Project
If you have questions about this post or about the Working Group, please contact Heather Holroyd, Community Based Research and Evaluation Coordinator: [email protected]