MONTREAL — A group of AIDS organizations wants Quebec to follow Ontario and France, and authorize community workers to screen for HIV using rapid tests.
The Coalition of Quebec Community Organizations for the Fight against AIDS (COCQ-SIDA) calls on the Legault government to ensure that this medical act is no longer reserved only for health professionals.
Extending this practice to community workers could, according to COCQ-SIDA, contribute to achieving one of the United Nations’ targets to eradicate the HIV epidemic by 2030, namely that 95% of people living with HIV know their status.
The COVID-19 pandemic has slowed HIV testing efforts in Quebec. The number of tests carried out fell from 413,197 to 337,158 between 2019 and 2020, a drop of 18.4%, says the Coalition.
In 2021, screening experienced some revival, but not to its pre-pandemic level. The figures for last year are not yet known.
“All the nursing resources that were previously engaged in local screening actions, in tandem with community workers, have been withdrawn from this action and put on COVID,” says Ken Monteith, executive director of COCQ-SIDA.
“We can understand that, but we can’t really cancel HIV testing,” he said in an interview.
According to him, community workers could have represented an alternative plan during the health crisis if they had been skilled in using rapid detection kits (RDTs).
“We know there are community responders who are trained and accredited to perform these rapid tests. We have partners in Ontario, France, Morocco and Ecuador who do it,” said Mr. Monteith.
He believes that the initiative could also be a way to ease the pressure on the health network. A rapid screening tool only requires confirmatory testing from a healthcare professional following a reactive result.
“Positive experiences” elsewhere
The Institut national de santé publique du Québec (INSPQ) looked at the community approach in its latest work on optimizing HIV in the province, published in 2019.
The INSPQ considers that adding community workers to health professionals “could optimize HIV testing in Quebec, (…) particularly among vulnerable communities that do not have easy access to testing services in clinical settings. “.
He emphasizes that “the French and American experiences are positive”.
“Community workers know the needs of the clienteles well and have work schedules adapted to the reality of the latter, can we read in the INSPQ report. Studies show that they are adept at developing the knowledge and skills to use RDT.”
The INSPQ’s analysis is shared by Mr. Monteith. The community sector is well placed to reach people who do not use the health network, either out of fear or because of bad experiences.
However, the INSPQ notes certain “significant, but not insurmountable issues” with community screening, such as a link to care that is more difficult than in a clinical setting for the confirmation of reactive cases.
In the office of the Minister of Health, they say they are “very sensitive to the requests” of the COCQ-SIDA.
“We all have the same objective, to improve access to quality care for all Quebecers, and we are ready to evaluate the various solutions to achieve this. We have asked the ministry and Public Health to come back to us with various proposals, ”said a press attaché for Minister Christian Dubé, in a written statement.
Join the 10%
Pending an expansion of screening by rapid detection kit, community organizations in Quebec have been able to benefit for several months from a federal program that provides access to self-testing kits.
Ottawa announced $8 million in funding last summer, allowing various organizations to distribute these self-tests.
Unlike rapid detection kits, the self-test cannot be administered by a community worker. The latter can only provide explanations on its use.
By the end of March, at least 54,335 self-testing kits had been given to communities across the country, including more than 4,000 in Quebec, according to Health Canada.
Of these kits, 6717 had been distributed to individuals in Canada, including 548 in Quebec.
The COCQ-SIDA indicates that the self-tests in the province had notably been distributed during individual interventions or events devoted to their promotion.
It is hoped that the rollout of these kits will help reach some of the 10% of Canadians living with HIV who were unaware of their status, according to end-2020 estimates from the Public Health Agency of Canada.
“We know that when a person knows their status, is connected to care and is on antiretroviral treatment, they no longer transmit HIV,” argues Mr. Monteith.
“So instead of having a pool of people who don’t know their status and who can transmit HIV, we want people to know their status as much as possible and be able to access the care they need, for their health, but also for public health,” he continued.
Until now, a third of people who have received a self-test in the country since the start of the federal initiative had never been screened, said Mr. Monteith.
However, Ottawa’s program is ad hoc until the end of the 2023-2024 fiscal year. COCQ-SIDA believes that the results of the next few months will demonstrate the relevance of sustaining the initiative.