Expanding access to HIV testing through Canadian community pharmacies: findings from the APPROACH study

Abstract

Background There is a need for acceptable and feasible HIV testing options to ensure people living with HIV know their status so they can access care. Pharmacist-provided HIV point-of-care testing (POCT) may overcome testing barriers, including privacy concerns, testing wait times, and improve accessibility. In the APPROACH study, we aimed to develop and assess an HIV POCT program in community pharmacies for future scale up and evaluation. This paper describes the program uptake, participant and pharmacist experiences, and implementation factors. Methods A pharmacist-provided HIV POCT program was offered in 4 pharmacies in two Canadian provinces. A mixed methods design incorporated self-report questionnaire data, participant telephone interviews, pharmacist focus groups, workload analysis, and situational analysis to assess the uptake, acceptability and feasibility of the HIV POCT program. Results Over the 6-month pilot, 123 HIV tests were performed. One new case of HIV was identified; this participant was linked with confirmatory testing and HIV care. Participants were predominantly male (76%), with a mean age of 35 years. This was the first HIV test for 27% participants, and 75% were at moderate to very high risk of undiagnosed HIV infection, by Denver HIV Risk Score. Questionnaires and telephone interviews showed participants were very satisfied with the program; 99% agreed HIV POCT should be routinely offered in pharmacies and 78% were willing to pay for the service. Participants felt the pharmacy was convenient, discreet, and that the pharmacist was supportive and provided education about how to reduce their future risk. Pharmacists felt prepared, confident, and expressed professional satisfaction with offering HIV POCT. Community and public health supports, clear linkage to care plans to refer participants with positive HIV POCT results, and provision of counselling tools were important enabling factors for the program. Pharmacist remuneration, integration with existing healthcare systems, and support for ongoing promotion of HIV POCT availability in pharmacies were identified as needs for future scale-up and sustainability. Conclusions A successful model of pharmacy-based POCT, including linkage to care, was developed. Further research is needed to determine the effectiveness and cost-effectiveness of this approach in finding new diagnoses and linking them with care. Trial registration Retrospectively registered with clinicaltrials.gov (NCT03210701) on July 6, 2017.

Sexual and reproductive health services provided by community pharmacists: a scoping review

“…42 44 HIV Among the seven studies focused on HIV, one evaluated pharmacist-led pre-exposure prophylaxis (PrEP), 51 and the remainder focused on HIV screening at the community pharmacy. [52][53][54][55][56][57] Havens et al implemented a pilot whereby individuals started on HIV PrEP could choose to be followed by a pharmacist for ongoing sexually transmitted infections (STI)/HIV screening, follow-up, and PrEP prescribing. 51 Although the authors described logistical challenges related to STI screening, results indicated that implementing a pharmacist-led PrEP programme was feasible and achieved high satisfaction rates among participants.…”

“…55 Studies that focused on HIV screening demonstrated pharmacists are capable of reaching high-risk groups and individuals not previously tested. [52][53][54][55][56][57] Crawford et al evaluated uptake of HIV testing when part of comprehensive disease screening implementation in low access and minority communities. 53 Kelly et al and Fernández-Balbuena et al found as low as 27% and as high as 52% of individuals reported they were not previously tested for HIV (or were unsure).…”

“…55 57 Some studies reported positive experiences with HIV screening at community pharmacies. 54 57 However, challenges were also reported, including recruitment and advertising, 54 56 57 obtaining the sample, 54 57 integration into the daily workflow, 57 pharmacists' remuneration, 54 57 costs 56 and referral and linkage to care. 52 Havens et al also described similar challenges for HIV PrEP services, such as integration into the daily workflow, pharmacist compensation, and cost for users and reimbursement policies.…”

Pharmacist-delivered HIV point-of-care testing in Ontario: Lessons learned from the GetaTest pilot

“…The findings from the GetaTest pilot project demonstrate the acceptability and feasibility of pharmacy-delivered HIV POCT, which is consistent with findings from the APPROACH study. 13 This pilot successfully increased rates of HIV testing for members of populations most affected by HIV and for people who had not previously tested for HIV. GetaTest also highlighted the critical role that pharmacists play in expanding access to HIV testing, the key first part of the HIV care cascade.…”

Evaluating HIV Rapid/Point of Care Testing among Risk Factor Groups in Ontario, 2011 to 2018

“…POC testing programs in a variety of settings have been shown to be acceptable, feasible and an important engagement tool for testing and linkage to care [ 2 ]. Models of delivering POC testing include primary care, STI clinics, community-based organizations and emergency departments [ 2 ], and have more recently expanded to pharmacies [ 3 ]. Additionally, home-based POC testing was licensed for use and sale in Canada in November 2020 [ 4 ].…”