“its different now”: the changing landscape of hiv testing
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“Its Different Now”: The Changing Landscape of HIV testing. Cristin Muecke, RMOH Nick Scott, ED AIDS NB. Objectives. Why HIV testing remains important Treatment as prevention Discuss advantages/disadvantages of various testing encounters - PowerPoint PPT PresentationTRANSCRIPT
“ITS DIFFERENT NOW”: THE CHANGING LANDSCAPE OF HIV
TESTING
Cristin Muecke, RMOHNick Scott, ED AIDS NB
Objectives 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
The Issue 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
The Issue• 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
The Canadian annual incidence rate has remained largely unchanged for the past decade (estimated 2300-4300 per year)
HAART Highly Active AntiRetroviral Therapy
makes it harder for the HIV virus to replicate, thus lower level of virus in the body
Implications for HIV positive patients: HIV infection is transformed from a death sentence to a
chronic, manageable condition
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”)
Treatment as prevention
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
Types of testing encounters
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
Why test patients with no risk factors?
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
Types of testing 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
Barriers to HIV testing in practice - real and perceived
Insufficient time Competing priorities Lack of knowledge and training Burden of consent, counselling
requirements Lack of patient acceptance Inadequate reimbursement Paperwork
What about pre-test counselling?
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.”
Moving forward
Prevention Education Support
On the Horizon - HIV prevention technologies -
HIV prevention options that are still in clinical trials Preventive vaccines Vaginal and rectal microbicides Pre-exposure prophylaxis(Treatment as prevention)(Medical male circumcision)
Questions/Discussion