Offering HIV Testing Routinely in Family Practice
Vancouver STOP Project
Vancouver, British Columbia
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“We made HIV testing more like other tests”
If you live in Vancouver and you’ve had an appointment with your family doctor in the last couple of years, you may have been offered an HIV test during your visit.
As part of a wider shift in Vancouver from risk-based HIV testing alone to a combination of risk-based and routine HIV testing, the Vancouver STOP Project, a collaboration between Providence Health Care and Vancouver Coastal Health, has been training and supporting family physicians to routinely offer HIV testing to all their patients. Dr. Réka Gustafson, Vancouver’s medical health officer for communicable diseases, recommends that all adults who haven’t been tested in the last year be offered the test. “Offering an HIV test has become more like offering other tests,” she adds.
In Canada, approximately 25 percent of people who are HIV-positive don’t know their status. In Vancouver, research from 2012 shows that 39 percent of people are diagnosed with HIV at the time of their first HIV test and that 60 percent of people are diagnosed with HIV so late that treatment is already indicated both of which suggest that there are not enough acceptable opportunities for testing. Roughly 20 percent of them are diagnosed with such advanced infection that they are already at risk for AIDS-defining infections like Kaposi’s sarcoma and oral thrush.
Late diagnosis is not entirely caused by avoidance of healthcare. Research demonstrates that it is common for multiple missed opportunities for diagnosis to be recorded in people’s medical histories before an HIV diagnosis is made. A missed opportunity is an instance in which an HIV test could have been offered or requested along with other blood tests during a patient’s visit to a healthcare setting, but it wasn’t. Often these opportunities are missed because doctors don’t consider HIV when a patient presents with symptoms consistent with HIV, unless they know the patient engages in behaviours that might put them at high risk.
Integrating the routine offer of HIV testing into family practice aims to remove barriers preventing people from receiving an early diagnosis by normalizing HIV testing for everyone. The Vancouver STOP Project has striven to ensure that family physicians have the tools, skills and support to routinely offer testing to patients.
According to Dr. Gurdeep Parhar, a family physician involved in the project, training family doctors to offer testing is key because they are “unlikely to become HIV experts and yet it’s people like me who will have to introduce HIV testing.”