Kielly Jason, Kelly Deborah V, Hughes Christine, Day Kristine, Hancock Stephanie, Asghari Shabnam, Gahagan Jacqueline, Marra Carlo, Nguyen Hai
1School of Pharmacy, Memorial University of Newfoundland, 75 Tiffany Court, St. John's, Newfoundland A1A 0L1 Canada.
2Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta Canada.
Pilot Feasibility Stud. 2018 Feb 27;4:59. doi: 10.1186/s40814-018-0252-1. eCollection 2018.
Approximately 1 in 5 Canadians with HIV are unaware of their status. In many provinces and especially rural communities, barriers to HIV testing include lack of access, privacy concerns, and stigma. The availability of HIV point-of-care testing (POCT) is limited across Canada. Pharmacists are well positioned to address barriers by offering rapid HIV POCT and facilitating linkage to care.
We will use a type-2 hybrid implementation-effectiveness design to assess a pilot HIV POCT model in one urban and one rural pharmacy in each of two Canadian provinces over 6 months. In this feasibility trial the research aims include developing and assisting pharmacies in implementing the model, evaluating processes/determinants of program implementation, evaluating the model's effects on client outcomes, preferences, and testing satisfaction. Using a community-based research approach, the research team will engage community stakeholders in each province including individuals with lived experience to inform the development of the pharmacy-based HIV testing model and support the research team throughout the study. A multipronged promotion campaign will be used to promote the study and facilitate recruitment. The pharmacy-based testing model will include pre/post-test counseling and linkage to care plans in addition to pharmacist-administered HIV POCT. Pharmacists will complete a comprehensive training program prior to implementing the testing model. Client demographics and satisfaction will be assessed by surveys and interviews. Pharmacists will document time required for testing and participate in a post-study focus group to discuss barriers/enablers. Implementation will be assessed qualitatively and quantitatively. The process of developing and implementing the model will be described using qualitative data and a logic model. Acceptability and barriers/enablers will be examined qualitatively based on survey responses. A preliminary costing assessment will consider the client, pharmacy, and government perspectives.
The results of this pilot will inform modifications to the HIV POCT model to optimize effectiveness and increase scalability. The study has national importance, providing valuable information on improving access to HIV testing. Future applications of this research may expand the role of pharmacists in offering POCT for other sexually transmitted/bloodborne infections as tests become available in Canada.
Clinicaltrials.gov, NCT03210701.
每5名感染艾滋病毒的加拿大人中约有1人不知道自己的感染状况。在许多省份，尤其是农村社区，艾滋病毒检测存在诸多障碍，包括难以获得检测、隐私担忧以及污名化问题。在加拿大，即时检测（POCT）艾滋病毒的可及性有限。药剂师有能力通过提供快速艾滋病毒即时检测并促进与医疗服务的衔接来消除这些障碍。
我们将采用2型混合实施-效果设计，在加拿大两个省份的各一家城市药房和一家农村药房对艾滋病毒即时检测试点模式进行为期6个月的评估。在这个可行性试验中，研究目标包括开发并协助药房实施该模式、评估项目实施的过程/决定因素、评估该模式对客户结果、偏好及检测满意度的影响。研究团队将采用基于社区的研究方法，让每个省份的社区利益相关者参与其中，包括有实际经验的个人，以指导基于药房的艾滋病毒检测模式的开发，并在整个研究过程中为研究团队提供支持。将开展多管齐下的宣传活动来推广该研究并促进招募工作。基于药房的检测模式除了由药剂师进行艾滋病毒即时检测外，还将包括检测前/检测后咨询以及与护理计划的衔接。药剂师在实施检测模式之前将完成一个全面的培训项目。将通过调查和访谈来评估客户的人口统计学特征和满意度。药剂师将记录检测所需时间，并参加研究后的焦点小组讨论，以探讨障碍/促进因素。将从定性和定量两方面对实施情况进行评估。将使用定性数据和逻辑模型来描述该模式的开发和实施过程。将根据调查回复从定性角度研究可接受性以及障碍/促进因素。初步成本评估将考虑客户、药房和政府的角度。
该试点的结果将为艾滋病毒即时检测模式的改进提供依据，以优化效果并提高可扩展性。这项研究具有全国性意义，为改善艾滋病毒检测的可及性提供了有价值的信息。随着加拿大可提供其他性传播/血源感染检测，这项研究的未来应用可能会扩大药剂师在提供即时检测方面的作用。
Clinicaltrials.gov，NCT03210701。
