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Guidelines use research evidence, the consensus of experts in the field, and practice-based evidence (that is evidence from knowledge and practical experience) to support the decision making of frontline service providers. Guidelines are issued by a variety of sources including governments and expert groups at the local, national and international levels. This article highlights HIV-related guidelines developed in Canada. While some of the guidelines are relevant across the country, others may have been developed for a particular context but may still contain information that may be of use to people in other regions.

Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis guidelines can include recommendations on screening people for PrEP use, prescribing PrEP, monitoring while on PrEP and stopping PrEP.

A group of clinicians, researchers and community members developed national guidelines for the prescribing of PrEP and post-exposure prophylaxis (PEP) in Canada. These guidelines include evidence-informed recommendations on how to assess patient eligibility for PrEP and how to correctly prescribe it.

Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis (2017) – Biomedical HIV Prevention Working Group of the CIHR Canadian, HIV Trials Network

Guidelines have also been developed to provide direction on PrEP delivery in specific provinces.

Alberta HIV pre-exposure prophylaxis (PrEP) guidelines (2021) – Alberta Health Services
Guidance for the use of pre-exposure prophylaxis (PrEP) for the prevention of HIV acquisition in British Columbia (2020) – British Columbia Centre for Excellence in HIV/AIDS
Pre-exposure prophylaxis: Guideline review for primary care practitioners in Saskatchewan (2019) –  Saskatchewan HIV Collaborative
La prophylaxie préexposition au virus de l'immunodéficience humaine : Guide pour les professionnels de la santé du Québec (2019) – Ministry of Health and Social Services of Quebec 9 (in French only)

Post-exposure prophylaxis (PEP)

Post-exposure prophylaxis guidelines cover the use of PEP after an occupational exposure, non-occupational exposure or both. They address infections, such as HIV, that may be transmitted by blood or other bodily fluids.

A group of clinicians, researchers and community members developed national guidelines for the prescribing of PEP and PrEP in Canada. These guidelines include evidence-informed recommendations on how to assess patient eligibility for PEP and how to correctly prescribe it.

Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis (2017) – Biomedical HIV Prevention Working Group of the CIHR Canadian, HIV Trials Network

Some provincial and territorial governments have also developed PEP guidelines. They provide recommendations on assessing whether a potential HIV exposure may require PEP, HIV testing of the person seeking PEP or the contact person, PEP drug regimens and the procedures to use when administering PEP. Some of these guidelines also provide information on local resources or copies of specific forms used in the province or territory.

Alberta guidelines for post-exposure management and prophylaxis: HIV, hepatitis B, hepatitis C and sexually transmitted infections  (2019) – Government of Alberta
Blood and body fluid exposure management (2018) – Yukon Health and Social Services
Guide pour la prophylaxie et le suivi après une exposition au VIH, au VHB et au VHC  (2019) – Ministry of Health and Social Services of Quebec (in French only)
Guidelines for the management of exposures to blood and body fluids (2013, with revisions in 2019 and 2020) – Government of Saskatchewan
Guidelines for the management of percutaneous or sexual exposure to bloodborne pathogens (2012) – Department of Health and Wellness, Prince Edward Island
Post-exposure prophylaxis for HIV, HBV and HCV: Integrated protocol for managing exposures to blood and body fluids in Manitoba (2019) – Manitoba Health, Seniors and Active Living

Distribution of harm reduction equipment

Harm reduction refers to policies, programs and services that aim to reduce the harms associated with drug use. Harm reduction programs help reduce the transmission of HIV and hepatitis C among people who use drugs. This resource examines the context and effectiveness of practices that facilitate safer drug use, such as the distribution of harm reduction equipment, and offers recommendations for the delivery of harm reduction services. It was updated in 2021.

Best practice recommendations for Canadian programs that provide harm reduction supplies to people who use drugs and are at risk for HIV, HCV, and other harms – Working Group on Best Practice for Harm Reduction Programs in Canada

Testing

Testing guidelines address a range of factors that need to be considered when delivering HIV testing. Recommendations commonly cover screening people for HIV testing, testing in specific populations, testing frequency and test counselling. Some testing guidelines also address legal and ethical issues such as confidentiality and disclosure, and technical issues such as test types and technologies.

In Canada, the Public Health Agency of Canada has developed a guide with general recommendations for HIV testing that can be taken into consideration alongside any existing local or specialized practices.

Human immunodeficiency virus: HIV screening and testing guide (2012) – Public Health Agency of Canada

A number of provinces have developed testing guidelines that reflect approaches and procedures specific to the province.

Guide québécois de dépistage des infections transmissibles sexuellement et par le sang (2019) – Ministry of Health and Social Services of Quebec (in French only)
HIV testing guidelines for the province of British Columbia (2014) – British Columbia Office of the Provincial Health Officer
Saskatchewan HIV testing policy: HIV testing in Saskatchewan (2014) – Saskatchewan HIV Provincial Leadership Team

Pregnancy

The Society of Obstetricians and Gynaecologists of Canada has developed several guidelines that address HIV-related considerations before, during and after pregnancy. They provide recommendations related to safer conception when one or both partners is living with HIV, HIV screening and testing during pregnancy, and the prevention of HIV transmission through pregnancy, childbirth and infant feeding.

Canadian HIV pregnancy planning guidelines (2018)

HIV screening in pregnancy (2006)

Guidelines for the care of pregnant women living with HIV and interventions to reduce perinatal transmission: Executive summary (2014)

Related guidance is also available from the Canadian Pediatric Society.

Please note that recommendations related to HIV transmission and infant feeding have evolved since these guidelines were first published. For more information, see the Expert consensus statement on breastfeeding and HIV in the United States and Canada.

In addition, this practice guide published in the Journal of the Association of Medical Microbiology and Infectious Disease Canada can be used to support healthcare providers’ use of the Canadian HIV pregnancy planning guidelines:

A clinical practice guide: What HIV care providers need to know about HIV pregnancy planning to optimize preconception care for their patients (2020)

Treatment guidelines

Treatment guidelines provide direction on when to start drug therapy and which drug regimens to use. Other topics that may be covered include drug therapy for different populations like treatment-experienced patients or pregnant people, monitoring tests, drug adherence and drug interactions.

Therapeutic guidelines for antiretroviral (ARV) treatment of adult HIV infection (2020) – British Columbia Centre for Excellence in HIV/AIDS

Healthcare management

Healthcare management guidelines provide recommendations on the delivery of routine healthcare for people living with HIV by physicians and other healthcare and service providers. Guidelines are also available for the treatment and care of other infections that may be of concern for people with HIV.

Clinical care guidelines for adults and adolescents living with HIV in Ontario, Canada (2017) – OHTN HIV Clinical Guidelines Working Group. The recommendations in these guidelines are organized around the HIV treatment cascade and address linkage to care and initial assessment, starting treatment, and ongoing care and retention in care.

Primary care guidelines for the management of HIV/AIDS in adults in British Columbia (2021) – British Columbia Centre for Excellence in HIV/AIDS. These guidelines address the testing and prevention of HIV-related conditions and the specific care of women, trans people and people who use substances, among other topics.

Saskatchewan HIV case management guiding principles (2016) – Saskatchewan HIV Collaborative. This guide provides a standardized approach for using case management in the province to support people living with HIV through the continuum of care. It outlines the potential components of a case management program to retain and engage people in HIV care, including intake and assessment and care team composition, among other considerations.

Le suivi de l'adulte vivant avec le virus de l'immunodéficience humaine (VIH) :  Guide pour les professionnels de la santé du Québec (2021) – Ministry of Health and Social Services of Quebec. The recommendations in these guidelines cover topics such as vaccinations, sexual and reproductive health, and diagnosis of HIV-related conditions. (in French only)

Caring for clients who are at risk for or living with HIV/AIDS: best practice guidelines (2013) – Canadian Association of Nurses in AIDS Care. These guidelines outline the recommended skills and practices for nurses who deliver HIV care.

Caring for women living with HIV: Women-centred HIV care (2020) – Centre for Effective Practice. This toolkit provides recommendations on delivering women-centred care to women living with HIV. It addresses person-centred care, HIV, trauma and violence, women’s health, mental and emotional health and peer support, leadership and capacity building.

Practice guidelines in peer health navigation for people living with HIV (2018) – These guidelines provide recommendations on the development, implementation and strengthening of peer health navigation programs that build the capacity of people living with HIV to self-manage their care and navigate systems of care. They were developed by a national expert working group with the support of CATIE.

Sexually transmitted and blood-borne infections: Guides for health professionals – Public Health Agency of Canada. These guidelines address the prevention, testing and care of sexually transmitted infections.

La prise en charge et le traitement de la syphilis chez les adultes infectés par le virus de l’immunodéficience humaine (VIH) : Guide pour les professionnels de la santé du Québec (2016) – Ministry of Health and Social Services of Quebec. These guidelines address the treatment and care of syphilis in people with HIV. (in French only)

For more Canadian and international guidelines, check out the CATIE website and stay tuned for a future Prevention in Focus article on additional Canadian harm reduction guidelines and manuals.

 

 

About the author(s)

Erica Lee is CATIE’s manager, website content and evaluation. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).