B.C. pioneers pharmacist-administered HIV testing in pilot program

The number of diagnosed HIV cases in Canada has been falling steadily in the last five years, thanks to greater public awareness, but there's a nagging concern that not everyone who should have an HIV test is getting one.

That concern has led authorities in British Columbia to launch an innovative pilot program allowing people to visit a pharmacist for a quick, reliable HIV test rather than see their doctor or wait at a clinic.

Four pharmacies, two in Vancouver and one each in Victoria and Nanaimo, will be offering something called the INSTI test, an HIV antibody test that takes only a few minutes and gives on-the-spot results to an accuracy of 99.8 per cent.

The program, set up by the Vancouver Coastal Health Authority and Providence Health Care, is said to be the first of its kind in Canada, so the results are likely to be studied carefully elsewhere.

The project was approved by the B.C. College of Pharmacists. The association that represents B.C. pharmacies is also welcoming it as a way for pharmacists to do more within the health-care system.

"I think it’s going to contribute to the expanding scope of practice of pharmacists and also help contribute to the public’s acceptance of a wider variety of services that they can receive in pharmacies," Derek Derosiers, director of pharmacy practice support for the 3,000-member B.C. Pharmacy Association, told Yahoo Canada News.

Work on other programs to expand HIV testing led the health authority to the conclusion many people were not being diagnosed early enough in their disease for the proven HIV drug cocktail to have the best effect, said Dr. Réka Gustafson, the authority's medical health officer and medical director of communicable disease control.

"We were surprised and perhaps a little chastened to find out we weren’t doing as well as we thought," she said in an interview with Yahoo Canada News.

"In fact about 60 per cent of patients were being diagnosed with HIV ... relatively late in the course of their disease, to the point they should already have been on treatment, and about a fifth of patients were diagnosed with advanced disease.”

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British Columbia, which has been on the front line since the early days of the HIV/AIDS epidemic, offers free, routine HIV testing in a variety of health settings, from family doctors to walk-in clinics and hospitals.

According to data from the Public Health Agency of Canada, B.C.'s rate of HIV-positive test reports for 2012, the last available year, was 5.1 per 100,000 population, lower than the national average of 5.9, and below all but the Atlantic provinces and the northern territories. Some 200 British Columbians test positive for HIV each year, Gustafson said.

"Many of them are young, healthy people who are going to be living with the infection for many, many years," she said.

“If you are diagnosed early in the course of the infection, you can expect to live to a near normal life span, you can have a positive reproductive future, you can have intimate relationships without infecting your partner.”

The province has offered HIV testing to all pregnant mothers as part of their pre-natal care for the last 20 years.

“The result of that was we aren’t missing HIV in pregnant women and there is no transmission from mother to child in our province," said Gustafson.

But pilot programs in the last five years to expand diagnosis and treatment opportunities forced officials to look closely at previously-held assumptions about the existing testing regimes.

For one thing, the strategy of targeting stereotypically high-risk groups, such as intravenous drug users and those who have unprotected sex, for testing was misguided.

“That’s because we now know the exercise of trying to determine who’s at risk and who’s not is not a very helpful one," said Gustafson. "It’s difficult to do in a clinical setting and our results weren’t very good.”

Many people are also not great at assessing their own risk level, which can delay their decision to get tested.

The answer was to expand routine testing, which in part helps decrease the stigma by offering it to anyone admitted to hospital and encouraging family doctors to offer it to their patients. That's helped double testing rates within the health authority's jurisdiction and resulted in more people being diagnosed earlier, said Gustafson.

“But we’re not there yet," she said. "Until you stop diagnosing people late in their disease, you’re not done.”

Allowing pharmacists to administer HIV tests is another possible avenue to reach people who may want to be tested but still feel uncomfortable approaching their GP or a clinic doctor.

The pharmacist-administered test itself takes about a minute to produce a result. Someone who tests positive then would be referred to a medical clinic – the pilot pharmacies are all attached to clinics – for another type of test to confirm the result.

“Because of the significance of such a diagnosis and because overall we don’t expect to find a lot of positives, it’s something we have to confirm," said Gustafson.

Pharmacists participating in the program will be trained on how to advise those who test positive for the virus. Desrosiers said it's helpful that pharmacists are experienced already in dealing with patients' confidential health information.

“This is certainly sensitive and there’s significant social stigma attached to this issue as well," he said.

[ Related: Top HIV/AIDS researcher Dr. Julio Montaner slams Ottawa for ignoring B.C.'s successful treatment ]

B.C. pharmacists have been pushing for some time to expand their role to take pressure off an overburdened health-care system.

The association produced a report last year recommending pharmacists be permitted to treat minor ailments such as headaches, back pain and heartburn that can take up close to 20 per cent of doctors' time.

B.C. pharmacists have been approved to administer flu vaccines for the last five years, Desrosiers noted. They gave 370,000 injections over the last flu season, up from 30,000 in the first year.

“The public is clearly accepting the growing scope of practice of pharmacists," he said.

Pharmacists are paid $10 for each vaccination. Desrosiers said if HIV-testing is expanded past the pilot program, he would expect a fee to be negotiated in line with the training required and the time needed to deal with each patient, especially if there is a positive result.

Gustafson said the pilot program will run for one year and the results evaluated to see if it merits expansion. But, she added, the first two weeks of operation have shown it's reaching a number of people who otherwise would not have been tested.