Cristin Muecke, RMOH
Nick Scott, ED AIDS NB
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Why HIV testing remains important
Treatment as prevention
Discuss advantages/disadvantages of various
testing encounters
Explore real and perceived barriers to HIV
testing in clinical practice
Promote normalization of HIV testing as part
of comprehensive STI testing approaches
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An estimated 25% of HIV infected persons in
Canada are unaware of their status
More likely to spread HIV in the population
 After being notified of their HIV status, newly
diagnosed people substantially reduce frequency of
unprotected behaviors
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A substantial number of HIV infected
persons are diagnosed late in their illness
 60% are diagnosed after they should already be on
treatment
 In US (2005), over a third of newly diagnosed
cases developed AIDS within a year
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The Canadian annual incidence rate has
remained largely unchanged for the past
decade (estimated 2300-4300 per year)
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Highly Active AntiRetroviral Therapy
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makes it harder for the HIV virus to replicate, thus lower
level of virus in the body
Implications for HIV positive patients:
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HIV infection is transformed from a death sentence to a
chronic, manageable condition
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If people are otherwise healthy, practicing safe sex, and
reducing other risks of transmission it is extremely
unlikely they will transmit HIV to another person while
on HAART (“treatment as prevention”)
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Concept pioneered by Dr. Julio Montaner and
team at BC Centre for Excellence in HIV/AIDS
HPTN 052 (phase 3 clinical trial)
 Randomized trial involving 1763 HIV discordant
couples in 9 countries
 Due to run until 2015, but interim results led
monitoring board to publicly release results in 2011
 Demonstrated a 96% reduction in risk of HIV
transmission for immediate versus delayed
HAART
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Client initiated – client asks for testing based
on perceived risk assessment
Risk assessment based – provider gathers info
on HIV risk factors, determines need for test
Routine provider initiated – use of a defined
threshold from which to offer HIV testing
Standard of care (“opt out”) – patient informed
that test will be performed as part of routine
screening unless it is specifically declined
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Everyone who has ever been sexually active is
at some risk of HIV
Patients don’t always know if they are at risk and
they rarely tell their health care providers even if
they do know
HIV testing is simple,
inexpensive, and acceptable
to most patients
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Nominal – normal lab testing with patient
identifiers
Non-nominal – lab testing using an identity
code that is only identifiable to patient and
provider
Anonymous – only legal use is for HIV testing;
only patient knows their true identity; patient
does not have access to early therapy or other
clinical supports without further identification
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Insufficient time
Competing priorities
Lack of knowledge and training
Burden of consent, counselling requirements
Lack of patient acceptance
Inadequate reimbursement
Paperwork
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Detailed pre-test counselling is increasingly
being recognized as a barrier to testing
For most patients, offer the test as part of
routine care and provide written info for those
who have questions
Sample statement: “I recommend an HIV test
for all my patients, whether or not they think
they are at risk.”
Prevention
 Education
 Support
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HIV prevention options that are still in clinical
trials
Preventive vaccines
 Vaginal and rectal microbicides
 Pre-exposure prophylaxis
(Treatment as prevention)
(Medical male circumcision)
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