Quebec community workers should be able to administer rapid HIV tests: coalition

The INSTI rapid HIV test, made by Richmond, B.C.-based bioLytical Labratories, works in 60 seconds and is available at select testing clinics in the Lower Mainland. (Handout)

A group of AIDS service organizations wants Quebec to follow in the footsteps of Ontario and France and allow community workers to screen for HIV using rapid tests.

A Quebec coalition of community groups fighting aids (COCQ-SIDA) is calling on the Legault government to allow certain non-medical professionals to administer the tests.

According to COCQ-SIDA, extending this practice to community workers could contribute to the United Nations' goal for 95 per cent of people living with HIV to know their status. It's a target in the UN's mission to eradicate the HIV epidemic by 2023.

The COVID-19 pandemic has slowed HIV testing efforts in Quebec. Between 2019 and 2020, the number of tests performed fell from 413,197 to 337,158, a decrease of 18.4 per cent, according to the coalition.

In 2021, there was some recovery in testing, but not to pre-pandemic levels. Figures for last year have yet to be made available.

"All of the nursing resources that were previously engaged in outreach, in tandem with community stakeholders, have been pulled out of that effort and put on COVID," said Ken Monteith, executive director of COCQ-SIDA.

"You can understand that, but you can't really cancel HIV testing."

Monteith said community workers could have filled in as backup during the pandemic if they had been skilled in using rapid detection kits.

"We know that there are community responders who are trained and certified to do these rapid tests. We have partners in Ontario, France, Morocco and Ecuador who are doing it," he said.

He believes the initiative could also be a way to ease the pressure on the healthcare system; a rapid screening tool only requires a confirmatory test from a healthcare provider if there's a reactive result.

'POSITIVE EXPERIENCES' ELSEWHERE

Quebec's public health institute (INSPQ) looked at a potential community-based approach in its 2019 report on optimizing HIV care in the province.

The INSPQ said community workers "could optimize HIV testing in Quebec [...], particularly among vulnerable communities that do not have easy access to testing services in clinical settings."

It points out that "the French and American experiences are positive."

"Community workers are well aware of the needs of their clients and have work schedules adapted to the reality of their clients," the INSPQ report states. "Studies show that they are able to develop the knowledge and skills to use [rapid detection kits]."

Monteith says the community setting is well-positioned to reach people who stay outside the healthcare system because of fear or bad experiences.

But the INSPQ notes some "important but not insurmountable challenges" with community-based screening; compared to clinical settings, there's a less direct link to care used to confirm reactive cases.

The Quebec health minister's office said it is "very sensitive to the requests" of COCQ-SIDA.

"We all have the same objective, to improve access to quality care for all Quebecers, and we are ready to evaluate the different solutions to achieve this. We have asked the ministry and Public Health to come back to us with different proposals," said a press secretary for Health Minister Christian Dubé in a written statement.

REACHING THE 10% MARK

While waiting for an expansion of rapid detection kit testing, community organizations in Quebec have taken advantage of a federal program that provides access to self-testing kits.

Last summer, Ottawa announced $8 million in funding, allowing various organizations to distribute these self-tests.

Community workers cannot administer the self-test -- they can only explain how to use it.

By the end of March, at least 54,335 self-testing kits had been distributed to communities nationwide, including more than 4,000 in Quebec, according to Health Canada.

Of these kits, 6717 had been distributed to individuals in Canada, with 548 of them in Quebec.

COCQ-SIDA reports that the self-testing kits in the province were distributed at individual interventions or events dedicated to their promotion.

The hope is that the rollout of these kits will help reach some of the 10 per cent of Canadians living with HIV who did not know their status, a 2020 estimate by the Public Health Agency of Canada.

"We know that when someone knows their status, is connected to care and is on antiretroviral therapy, they are no longer transmitting HIV," Monteith said.

"So instead of having a pool of people who don't know their status and can transmit HIV, we want as much as possible for people to know their status and be able to access the care they need, for their health, but also for the public health."

The Ottawa program is a one-time initiative lasting until the end of the 2023-2024 fiscal year.

COCQ-SIDA believes the results of the next few months will inform whether the program should be made permanent.