Leonard Lynne Elizabeth, Vannice Sarah, Wilson Lindsay, McCellan Celia, Lepage Candis
HIV and HCV Prevention Research Team, School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
Front Public Health. 2020 Mar 18;8:53. doi: 10.3389/fpubh.2020.00053. eCollection 2020.
Canadian epidemiologic data demonstrate the fallibility of established HIV testing approaches to reach, diagnose, and link to care a significant portion of the population thereby contributing to missed opportunities to reduce onward HIV transmission. Increasing and diversifying entry points to accessing HIV testing may be a successful strategy to reach people who remain undiagnosed. We sought to determine the perspectives of patients on the acceptability of an offer of routine non-targeted provider-initiated HIV counseling and point-of-care (POC) testing in the health services program of a Community Health Centre in downtown Ottawa, the capital of Canada. Patients aged 18 years and over accessing the Health Services Program for scheduled clinical appointments were approached by research staff with the offer of a POC HIV test with pre- and post-test counseling. All patients accepting the offer and those declining the offer were offered the opportunity to complete an Acceptability Questionnaire. Questionnaire responses from eligible patients over four consecutive weeks in 2018 strongly endorse the acceptability of an offer of an HIV test in the context of their scheduled health services appointment for a separate clinical condition. This contention held both for those patients accepting the offer and proceeding to testing and for those patients declining the offer. The perspectives of the patients in our study demonstrate that a routine offer of non-targeted provider-initiated HIV counseling and POC testing was considered not only to be an acceptable, but also an appropriate and welcome intervention in a community health services program. These results suggest the potential for actively engaging more individuals-including those less likely to be engaged through a targeted testing approach-in the documented benefits of the HIV care and treatment cascade by increasing the HIV test offer through routine provider initiation. In addition, at the population level, shifting the offer through venue diversification, similarly shows potential for reducing engagement in ongoing HIV transmission behaviors and practices attributed to those unaware of their HIV positive status. Both outcomes fundamental to the goal of eliminating AIDS by 2030.
加拿大的流行病学数据表明，既定的艾滋病毒检测方法在覆盖、诊断以及将相当一部分人群与治疗相联系方面存在缺陷，从而导致减少艾滋病毒进一步传播的机会被错失。增加艾滋病毒检测的切入点并使其多样化，可能是接触未被诊断人群的成功策略。我们试图确定患者对于在加拿大首都渥太华市中心的一个社区卫生中心的健康服务项目中，由医护人员主动提供常规非针对性艾滋病毒咨询和即时检测（POC）的接受度。研究人员向年龄在18岁及以上、前来健康服务项目进行定期临床预约的患者提供即时艾滋病毒检测以及检测前后的咨询服务。所有接受该提议的患者以及拒绝该提议的患者都有机会填写一份接受度调查问卷。2018年连续四周符合条件的患者的问卷回复强烈支持在他们因其他临床病症进行定期健康服务预约时提供艾滋病毒检测这一提议的可接受性。这一观点对于接受提议并进行检测的患者以及拒绝提议的患者均成立。我们研究中患者的观点表明，在社区卫生服务项目中，由医护人员主动提供常规非针对性艾滋病毒咨询和即时检测不仅被认为是可接受的，而且是适当且受欢迎的干预措施。这些结果表明，通过医护人员常规主动提供艾滋病毒检测，有可能让更多人——包括那些通过针对性检测方法较难接触到的人——积极参与到艾滋病毒护理和治疗流程所记录的益处中来。此外，在人群层面，通过改变检测地点来提供检测，同样显示出减少因不知自己艾滋病毒呈阳性而持续存在的艾滋病毒传播行为和做法的可能性。这两个结果对于到2030年消除艾滋病的目标至关重要。
