Programming Connection

Routine HIV Testing in Acute Care 

Vancouver STOP Project
Vancouver, British Columbia
2013

Introduction

“We feel like we moved a mountain.”

It’s hard to miss the posters and the banners as you walk into any hospital in Vancouver. They all claim that HIV testing is “different now.” And in Vancouver, it is. Since October 2011, everyone admitted to four hospitals in Vancouver—St. Paul’s Hospital, Mount Saint Joseph Hospital, Vancouver General Hospital, and the University of British Columbia Hospital—should be offered an HIV test as part of routine care. This is a dramatic shift in the HIV testing paradigm in the city. “We feel like we moved a mountain,” says Réka Gustafson, one of Vancouver’s medical health officers and director of Vancouver Coastal Health Disease Control

The goal of this initiative, and other testing programs developed by the Vancouver Seek and Treat for Optimal Prevention of HIV/AIDS (STOP) Project and its partners between 2010 and 2013, is to expand testing opportunities for everyone in Vancouver and thus increase early diagnosis. Early diagnosis is the first step in the treatment cascade and allows people living with HIV to benefit from treatment, care and support that is available and effective. Early diagnosis is better because it allows a person that is ready to engage in care to optimize the benefits of treatment, care and support

The phased integration of a routine offer of HIV testing in hospitals has been a success. Not only is the routine offer of testing acceptable to people in Vancouver (the acceptance rate across hospitals is 94 percent), but as of May 2012, the initiative has made between three and eight new HIV-positive diagnoses for every 1000 tests performed. This makes the initiative highly cost-effective.

Although successful, the rollout has also been challenging.  In the absence of provincial or national recommendations on HIV testing, the Vancouver STOP Project had to develop a solid clinical and public health rationale for a routine offer of testing. Barriers between people and testing also had to be reduced. This included the simplification of pre-test guidelines, though rightly, the need for verbal informed consent for each test was maintained.

In addition, barriers between providers and the routine offer of testing had to be reduced. The primary concern of healthcare providers in hospitals was the time and expertise needed to provide follow-up and linkage-to-care services for people newly diagnosed with HIV. While hospital physicians can continue to offer these services if they want, for those who do not have the skills, a follow-up process was articulated that allows physicians to delegate these responsibilities to nurses from the Vancouver Coastal Health Communicable Disease Control.

The initiative, and the policy changes required to integrate routinely offering HIV testing to all patients in hospitals in Vancouver, have contributed to making HIV tests more like other diagnostic tests performed hundreds of times a day in hospitals across Vancouver. “We have affected the knowledge of patients, the providers, and the general public about HIV testing, HIV infection and the benefits of treatment,” says Afshan Nathoo, the Clinical Leader of the initiative.