Laprise Claudie, Bolster-Foucault Clara
Public Health Agency of Canada, Health Security and Infrastructure Branch, Public Health Capacity and Knowledge Management Unit, Québec Regional Office; Montréal, QC.
Can Commun Dis Rep. 2021 Mar 4;47(2):105-125. doi: 10.14745/ccdr.v47i02a03.
BACKGROUND: HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed. OBJECTIVE: To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada. METHODS: A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized. RESULTS: Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices. CONCLUSION: Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.
背景：艾滋病毒检测是加拿大性传播和血源性感染（STBBI）预防与治疗方法的核心支柱，对于实现联合国艾滋病规划署（UNAIDS）首个90-90-90目标至关重要。尽管在实现这一目标方面取得了进展，但许多加拿大人仍不清楚自己的感染状况，而且不同人群和司法管辖区的检测情况存在差异。了解艾滋病毒检测的驱动因素对于改善艾滋病毒检测的可及性和发现未被诊断的感染者至关重要。 目的：研究加拿大主要人群和司法管辖区目前艾滋病毒检测的障碍和促进因素。 方法：对同行评审文献和灰色文献进行系统的混合研究综述，识别2009年至2019年发表的关于加拿大艾滋病毒检测障碍和促进因素的定量和定性研究。对研究进行筛选以确定是否纳入，提取已识别的障碍和促进因素。评估纳入研究的质量并总结结果。 结果：共识别出43项相关研究。在主要人群和司法管辖区中出现了一些常见障碍，包括难以获得检测服务、对艾滋病毒的恐惧和污名化、低风险认知、患者保密不足以及检测资源匮乏。还识别出了一些可促进艾滋病毒检测的创新做法，如新的检测场所（牙科护理、药店、移动检测单位、急诊科）、新的检测方式（口腔检测、同伴咨询）以及基于性/性别和年龄的个性化干预措施和方法。主要人群在艾滋病毒检测方面还面临独特的社会文化、结构和立法障碍。许多研究指出需要提供广泛的检测选择，并将检测纳入常规医疗实践中。 结论：改善艾滋病毒检测可及性的努力应考虑个人、医疗服务提供者以及政策层面的障碍和促进因素，并应关注检测服务的可及性、包容性、便利性和保密性。此外，检测服务必须适应主要人群的独特需求和背景。
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