Sunshine Coast and Powell River to receive routine HIV testing this month

Starting later this month, family practice and hospital physicians in Powell River and Sunshine Coast will be offering an HIV test to patients as part of routine care when ordering other blood tests. Following on the heels of successful rollouts in Vancouver, Richmond, and North Shore hospitals and community sites – including Lions Gate Hospital in January – routine testing will also expand to Powell River General Hospital and the Sunshine Coast over the coming months. Testing will begin in Powell River on May 15 and at St. Mary’s on May 29.

By implementing routine, provider-initiated testing, VCH will help reduce the stigma associated with HIV testing and improve early diagnosis of HIV infection. It is well established that early diagnosis of HIV, like many other chronic diseases, allows individuals to fully benefit from treatment, which improves quality and prolongs people’s lives.

Admission to hospital is an excellent opportunity to test all patients for HIV as studies have found that testing based solely on risk misses a substantial proportion of people with HIV. Most patients are at very low risk and will have a negative test result, but everyone who has ever been sexually active is at some risk of HIV. The Public Health Agency of Canada estimates one quarter of those living with HIV don’t know it; this adds up to about 3,500 BC residents.

During the pilot phase in Vancouver, it was found that 94% of patients accepted an HIV testing when it was offered by their health care provider (of more than 5,000 patients accepting the offer between Oct. 2011 – June 2013).

We know routine HIV testing works. Testing for HIV has already been included in routine care for all pregnant women in B.C. for many years. Most women are at low risk, but routine testing has almost eliminated mother-to-child transmission of HIV. In some Vancouver hospitals, routine HIV testing has been in place for almost three years and the positivity rate is approximately 3 per 1,000 patients among patients admitted to acute care. This is three times the cost-effectiveness threshold of 1 per 1,000.

Like diabetes, there is no cure for HIV. However, people with HIV who are diagnosed at an early stage of infection and treated can stay healthy. Also, when patients regularly take HIV medication, they’re less likely to pass the virus onto others. It’s up to us to identify those unaware and help them access treatment and support services.

HIV status affects many aspects of clinical care including treatment of infections and cancers, as well as basic health care such as immunizations. Knowing a patient’s HIV status should be a part of routine care.

The expansion of routine HIV testing in hospitals is part of the provincially funded Hope to Health HIV Initiative, which builds on the successful outcomes of the “Seek and Treat for Optimal Prevention (STOP) of HIV/AIDS” pilot project that ran from 2010-2013 in Vancouver and Prince George. Hope to Health is designed to expand prevention, testing, treatment, and support services to clinically eligible individuals in British Columbia.

Good information for staff and physicians to use when discussing routine HIV testing with patients and family members

Why is VCH implementing HIV routine testing into acute care?

• Early diagnosis is known to improve patient outcomes and reduce the risk of transmission.
• People are not being diagnosed early enough. 60% of HIV patients are diagnosed after they should already be on treatment.
• Screening based solely on risk misses a substantial proportion of people with HIV. Patients are frequently unaware of their risk or if they are aware, they often do not disclose to their health care provider.
• Evidence shows that most people newly diagnosed with HIV have had many missed opportunities in health care for HIV diagnosis. Admission to hospital is an excellent opportunity to screen all patients for HIV.
• Routine HIV testing of all patients reduces stigma and improves early detection.
• HIV infection should be treated as early as possible. Early treatment prolongs and improves people’s lives. People on treatment can have healthy lives, relationships, and children.
• Most patients we test are at very low risk and will have a negative test. But, the only way to know for sure is to have a test.
• It’s just as important for us to know if you are negative as knowing if you are positive.