Preferences for Rapid Point-of-Care (POC) HIV Testing in Nova Scotia Discussion From a health equity perspective, rapid POC HIV testing: • Is as desirable in a small city in the Atlantic Provinces as it is elsewhere in North America. • May reduce opportunity costs to being tested in provinces where there are few anonymous HIV testing and clients must travel (Nova Scotia has only two sites). • May reduce the proportion of Atlantic Canadians are unaware of their HIV status (estimated at 26% in Canada as a whole). Nathaniel M. Lewis, PhD a and Jacqueline C. Gahagan, PhD a Introduction The rapid point-of-care (POC) test for human immunodeficiency virus (HIV) is an immunoassay that tests for the reactivity of a blood or saliva sample with an enzyme sensitive to HIV antibodies. The test takes ~2 minutes (compared to 1 week of lab processing for standard Western Blot tests). Because of its convenience, rapid POC testing has been observed to: • Increase HIV testing uptake. 1,4,5,6 • Increase the receipt of test results. 4,5,6,7 • Increase rates of testing among high-risk clients when provided anonymously. 4,7 Authorized by the Public Health Agency of Canada (PHAC) in 2005, rapid POC testing has not been implemented evenly in Canada (see Fig. 1). • Ontario and British Columbia have over 50 rapid POC HIV testing sites each. • Most provinces have at least one site or are have piloted rapid POC testing. • The Atlantic Provinces have no POC sites. Methods Between September 1, 2011 and April 30, 2012, anonymous HIV testing (AHT) clients at a sexual health clinic in Halifax were surveyed regarding: • Their preference for rapid POC HIV testing vs. the standard testing offered. • Reasons for their preferences. • Other testing concerns (e.g., anonymity). The results were compared to existing studies of rapid testing acceptability (see Table 1). Results The questionnaire (n=258) found: • The level of acceptability in Halifax (90.3%) was similar to that in larger areas. • The rate of standard testing clients who currently return to get their results was 87.8% (rapid POC typically produces ~100% receipt rates). 4,5,6,7 • Results may differ b/w methodologies (survey vs. test choice) and site (clinic vs. mobile). Figure 1: Locations of rapid POC HIV testing sites in Canada. 2010 Pilot 2007 2012 2006 2010 1 2 4 (Montreal & Hamilton) 7 (Ottawa) ~ 20 (Greater Toronto ) ~30 (Greater Vancouver ) 2010 Year rapid POC testing implemented (provincial guidelines established) study site Study Location of study n Method of determining Preference Percentage indicating preference for rapid POC test Percentage of rapid POC testers receiving results/ counseling Percentage indicating preference for standard test or no preference Percentage of standard testers receiving results/ counseling Current study Sexual health clinic, Halifax, Canada 258 survey 90.3% NA 9.7% 87.8% A Schwandt et al. (2012) 1 Primary care facility, Toronto, Canada 104 survey 81.1% NA 18.9% NA Keller et al. (2011) 2 Mobile screening clinic, Baltimore, U.S.A. 5101 choice of testing offered 44.4% B NA 55.6% NA Marsh et al. (2010) 3 Community and mobile clinics, Los Angeles County, U.S.A. 2752 choice of testing offered 33.3% B NA 66.7% NA Guenter et al. (2008) 4 Sexual health clinic, Toronto, Canada 1610 choice of testing offered 91.1% 100.0% initial result, 81.8% of reactive returned for confirmatory 8.8% 90.8% San Antonio- Gaddy et al. (2006) 5 AHT Program (multiple sites), New York, U.S.A. C 6187 choice of testing offered 93.2% D 100.0% initial result 6.3% D 85.8% Kendrick et al. (2005) 6 Walk-in STD clinic, Chicago, U.S.A. 1581 choice of testing offered 86.8% 98.9% initial result 13.2% NA Liang et al. (2005) 7 Mobile screening clinic, Baltimore, U.S.A. 439 choice of testing offered 64.5% B 92.6% initial result 35.5% 40.3% Spielberg et al. (2003) 8 STD clinic, needle exchange, and MSM sex venues, Seattle, U.S.A. E 139 survey 32.4% F NA 12.9% F NA Table 1: Studies of rapid POC testing acceptability and efficacy (receipt of test results) in North America. References 1.Schwandt M, Nicolle E, Dunn S. Preferences for rapid point-of-care HIV Testing in primary care. JIAPAC 2012; 11: 157-163. 2.Keller S, Jones J, Erbelding E, et al. Choice of Rapid HIV testing and entrance into care in the Baltimore City sexually transmitted infections clinics. AIDS Patient Care STDs 2011; 25: 237–243. 3.Marsh KA, Reynolds GL, Rogala BE, et al. Who chooses a rapid test for HIV in Los Angeles County, CA? Eval Health Prof 2010; 33: 177–196. 4.Guenter D, Greer J, Barbara A, et al. Rapid point-of-care HIV testing in community- based anonymous testing program: a valuable alternative to conventional testing. AIDS Patient Care STDs 2008; 22: 195–204. 5.San Antonio-Gaddy M, Richardson-Moore A, et al. Rapid HIV Antibody Testing in the New York State Anonymous HIV Counseling and Testing Program: Experience from the Field. JAIDS 2006; 43: 446–450. 6.Kendrick SR, Kroc KA, Withum D, et al. Outcomes of offering rapid point-of-care HIV testing in a sexually transmitted disease clinic. JAIDS 2005; 38: 142-146. 7.Liang TS, Erbelding E, Jacob CA, et al. Rapid HIV testing of clients of a mobile STD/HIV clinic. AIDS Patient Care STDs 2005; 19: 253–257. 8.Spielberg F, Branson BM, Goldbaum GM, et al. Overcoming barriers to HIV testing: preferences for new strategies among clients of a needle exchange, a sexually transmitted disease clinic, and sex venues for men who have sex with men. JAIDS 2003; 32: 318–327. A Indicates the rate of non-return for all AHT clients receiving testing from 4-1-11 to 9-30-11 (n=411). B Indicates saliva-based rather than blood-based rapid POC testing. C Included some prisons and jails as well as community-based settings; data were not available separately. D Figures do not add up to 100.0% because oral test (standard) was also given as a testing option. E Figures are for the STD clinic study only. F Figures do not add up to 100.0% because home test (rapid), oral test (standard), urine test, and home specimen collection were listed as options in addition to rapid POC blood test and standard blood test. a. Gender and Health Promotion Studies Unit, School of Health and Human Performance, Dalhousie University, Nova Scotia, Canada, B3H 4R2. E-mail: gahps@dal.ca.