What’s it all about: Pharmacy Testing

February 12, 2020

Recent news reports have made HIV testing in pharmacies one of the hot topics of the moment in Ontario. As part of a pilot by the Ontario HIV Treatment Network (OHTN) called Get a Test, people in Ottawa and Toronto can access free, one-minute HIV testing in two local pharmacies. Here, we take a look at this innovative project which aims to make getting tested for HIV more accessible than ever before.

How does it work?

On selected days, customers can visit The Village Pharmacy in Toronto or the Shoppers Drug Mart Bank & Gladstone in Ottawa to receive free one-minute INSTI HIV tests, delivered by a trained pharmacist.

Alexandra Musten, Senior Lead of Testing & Clinical Initiatives of the OHTN explains what people can expect from a visit. “When a client arrives to one of the two participating pharmacy sites, they can request the test directly at the pharmacy counter,” she says. “If people feel uncomfortable requesting the test out loud, they can also pass a note to the pharmacist like a prescription. Clients who meet the eligibility criteria will be invited to the pharmacist’s confidential room where the test will be performed.

She adds, “No appointment is required at this time, both sites are walk-in. The test is free of charge, and clients are invited to complete the post-test survey so we can learn about their experience testing.”

What happens if a test is reactive?

Alexandra  says, “Clients who receive a reactive result will be immediately linked to care, where they will receive confirmatory bloodwork and treatment.” As INSTI is a screening test for HIV, it’s always necessary to follow up with a confirmatory test.

The pharmacists are specially trained to deliver the test, and answer questions about HIV prevention and treatment, in a caring and confidential manner. Clients also receive guidance on programs and services in the community that can help meet individuals’ specific needs.

Ben Gunter, the pharmacist at the Ottawa Shoppers Drug Mart says that getting tested is the start of a crucial journey, whether the result is reactive or non-reactive. He explains, “Patients that get diagnosed and begin treatment early, live long healthy lives. We know that patients on treatment can become undetectable, which means their viral load will be below detectable levels. This eliminates the risk of further sexual transmission. Knowing your status is the best way to keep yourself and others healthy.”What are the aims of this pilot?

Jean Bacon, Executive Director of the OHTN says that one of the main objectives is to reach those who do not know their status. She explains, “While more than 8 out of 10 people living with HIV in Ontario have been diagnosed, we estimate that about 14% – or about 3,000 – do not know they have HIV. Our goal is to reach these individuals, get them tested and link them to care if they are positive and to prevention programs, like PrEP, if they are negative. Getting people with HIV on treatment is critically important both for their health and to reduce the risk of onward transmission. Evidence shows that people with HIV who are on treatment and virally suppressed cannot pass the virus to their sexual partners.”

According to Jean, there are many reasons why pharmacists have been selected to deliver testing, including their connections with local communities. She says, “We think that pharmacy testing can be a highly effective way to achieve these goals. We know that Ontarians trust pharmacists, and engaging pharmacists early can help with medication adherence later on. We also think that making HIV testing available in pharmacies where people go for many other health needs will help reduce any stigma associated with HIV testing. Pharmacies also offer convenient testing hours, as they’re often open later than clinics and during weekends and holidays.”

Ben adds, “We simply want to offer another access point, to help reduce the gap in the percentage of undiagnosed.”

At the end of the pilot, the OHTN will evaluate the results to see if pharmacist-delivered point-of-care testing in some Ontario pharmacies can help more people living with HIV to learn their status. A report will be posted on ohtn.on.ca after the pilots are complete.

How was this testing pilot set up?

Alex explains, “For this pilot, the OHTN chose two pharmacies that had strong relationships with their communities and a commitment to providing high quality care for people living with HIV. The OHTN and the pharmacists worked closely with Dr. Deborah Kelly from Memorial University who has successfully launched four pharmacy testing pilots in Alberta and Newfoundland and Labrador. The pharmacists completed the same training as other testers providing HIV point-of-care testing in Ontario. The OHTN also worked with the pharmacists to develop easy-to-read handouts about the testing and to identify local physicians who would provide care to anyone who had a reactive test. Anyone who has a reactive test is immediately referred to the physician who orders the confirmatory test and can start the person on treatment.”

Other pilots have previously taken place in regions including British Columbia and in Saskatchewan. One of the findings from these pilots was that visiting a pharmacy makes testing more convenient for first time and frequent testers. A high percentage of individuals at tested at the pharmacies had never been tested for HIV previously.

Is this related to the news that INSTI’s Intended Use was expanded or that self-testing trials are happening all over Canada?

No, they’re different stories. What they have in common is the aim to make sure all Canadians have easy access to HIV testing. The amendment to INSTI’s Intended Use statement does allow for an expanded range of health care professionals to perform INSTI HIV tests at point of care sites in Canada, but how that is implemented depends on the rules in each province. The exciting HIV self-testing trials using INSTI are funded by the CIHR Centre for REACH 3.0 and the Canadian Foundation for AIDS Research (CANFAR). They are part of a study to establish whether HIV self-testing is a suitable additional option for people in Canada to test for HIV. The recent Ontario pharmacy HIV testing pilots are the result of the OHTN’s hard work and part of their plan to find more ways for people in Ontario to learn their HIV status.

How are the trials going so far?

Zahid Somani explains the pharmacy HIV testing program to City of Toronto Councillor Kristyn Wong-Tam

Zahid Somani explains the pharmacy HIV testing program to City of Toronto Councillor Kristyn Wong-Tam.

One of the pharmacists involved in this project, Zahid Somani of Toronto’s The Village Pharmacy, reports that the trial is going well, and that its impact extends beyond the twice-weekly testing sessions. He says, “HIV testing at The Village Pharmacy has been positively embraced by Torontonians, and supported by local AIDS services organizations who

refer some of their clients to the pharmacy for testing.  In just under 2 months, we’ve conducted over 150 HIV tests, which speaks to the continued need for easy access to HIV testing in Toronto. People who come in to the Pharmacy for testing find that it is easy, convenient, and discreet. Plus, they’re really impressed at how quickly results are available!

“The testing process has provided a welcoming platform to discuss HIV risk factors, educate and dispel myths about HIV transmission, and provide counselling to testing clients on a variety of mental and sexual health concerns, including PrEP and PEP. We provide a package of resources that our clients walk away with, so they have easy access to information on HIV infection and local community services they can access.

“It’s been a really positive experience for us as pharmacists as well – we’re able to proactively apply our deep expertise in HIV to positively impact a key issue facing public health in our city. With over 500 new HIV infections in Toronto last year, we’re hopeful that the HIV testing pilot at The Village Pharmacy will demonstrate that this initiative can be scaled to reach even more people, and further the Toronto to Zero goal to make new HIV infections rare.”

How can I access pharmacy HIV testing?  

Visit the Get a Test website to find more information.

In Toronto you can visit The Village Pharmacy at 353 Yonge Street

Every Friday – 10am to 5pm
Every Saturday –10am to 5pm

In Ottawa you can visit Shoppers Drug Mart at 455 Bank Street

Every Monday night from 5pm – 9pm

Remember: Bring your Ontario Health Card if you can, it makes your visit a little more efficient. If you don’t have it, no problem, you can still access the service.

Images courtesy of the Ontario HIV Treatment Network (OHTN) The Village Pharmacy and Shoppers Drug Mart Bank & Gladstone.

 

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