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Know your status

Pharmacies 'ideally placed' to address gap in HIV, hepatitis C and syphilis testing

By Amanda Butt

Free, quick, confidential HIV, hepatitis C, and syphilis testing in select community pharmacies.

Dr. Debbie Kelly has her arms folded and is standing in front of a wall of windows.
The School of Pharmacy’s Dr. Debbie Kelly is the principal investigator of the national APPROACH study.
Photo: Rich Blenkinsopp

Launching on Dec. 1, World AIDS Day, the APPROACH (adaptation of point of care testing for pharmacies to reduce risk and optimize access to care in HIV, HCV and syphilis) study encourages people to know their status.

Through this research study, people will be able to access free, quick, confidential testing for HIV, hepatitis C and syphilis in participating pharmacies throughout Newfoundland and Labrador, Nova Scotia and Alberta during a one-year period.

The APPROACH study is funded by a research grant from the Canadian Institutes for Health Research and is a partnership between Memorial University’s School of Pharmacy, Nova Scotia Health, the University of Alberta’s Faculty of Pharmaceutical Sciences, peer researchers and community partners.

The issue

Sexually transmitted blood-borne infections (STBBI) are a significant challenge across Canada.

Cases of HIV, hepatitis C, syphilis and other STBBI are on the rise, yet 14 per cent of people with HIV and 40 per cent of those with hepatitis C don’t know their status.

Uncontrolled infections can lead to serious complications, but both hepatitis C and syphilis are curable infections. HIV is treatable with no risk of transmission to sexual partners when the infection is controlled.

A pink poster with the words "get tested" above illustrations of an eggplant and a peach. The words HIV, hepatitis C an syphilis tests and a QR code are below.

However, people can’t access treatment if they don’t know their status.

“Access to STBBI testing has always been a challenge, whether due to stigma, a low perceived risk of infection or a physical lack of access to a primary care provider, sexual health clinic or community testing site,” said Dr. Debbie Kelly, professor, School of Pharmacy, Memorial University, and principal investigator of the APPROACH study. “But since the COVID-19 pandemic, it’s gotten even worse.”

According to a survey conducted by the Public Health Agency of Canada, 66 per cent of service providers reported a decrease in demand for STBBI prevention, testing and treatment services since the start of the pandemic, and 44 per cent reported a strong decrease in their ability to provide these services.

Yet, provinces are seeing increased cases and case clusters or outbreaks of syphilis, hepatitis C and HIV, and other STIs.

Also, reported case numbers are likely an underestimate of the true prevalence of infections due to lack of testing.

Community pharmacists: ideally placed

The lack of accessible and acceptable testing options — especially for those without a primary care provider and people living in rural and remote areas — means that more cases are diagnosed late in advanced stages of infection or not diagnosed at all.

Community pharmacists are ideally placed to address this care gap.

In the APPROACH pilot study, 123 rapid HIV tests were performed over six months in two pharmacies in each of Newfoundland and Labrador and Alberta.

“It’s discreet, professional and easy to access. There’s a pharmacy in virtually every community.” — Gerard Yetman

One new case of HIV was diagnosed; this person was directly connected with care and treatment.

More than 99 per cent of participants felt that testing should be offered routinely through pharmacies.

Gerard Yetman, executive director, AIDS Committee of N.L., says there is a “real need” for better access to testing for HIV, as well as hepatitis C.

“People seem to really like getting tested at the pharmacy,” he said. “It’s discreet, professional and easy to access. There’s a pharmacy in virtually every community.”

APPROACH 2.0

The new APPROACH study builds on successes and lessons learned in the pilot study and will offer not only HIV testing, but also testing for hepatitis C and syphilis at the pharmacy.

It is funded as part of the REACHing for Impact Canadian Institutes of Health Research team grant – HIV/AIDS Biomedical and Clinical Research and will offer testing in participating pharmacies in Newfoundland and Labrador, Nova Scotia and Alberta over a one-year period.

“People can choose to get a rapid, finger stick test for HIV or for hepatitis C that gives their screening results within minutes, right there at the pharmacy.” — Dr. Debbie Kelly

The study aims to assess how pharmacy-based testing can contribute to finding new STBBI diagnoses and linking them with care and treatment.

The goal is to identify ways to create an attractive, effective and sustainable pharmacy-based STBBI testing program in Canadian provinces.

The pharmacy-based testing model is based on a harm-reduction approach and aims to create safe, welcoming spaces where people want to go to get tested, receive education and get linked with prevention and treatment services.

“People can choose to get a rapid, finger stick test for HIV or for hepatitis C that gives their screening results within minutes, right there at the pharmacy,” said Dr. Kelly. “Or they can get a dried bloodspot test, which can test for HIV, hepatitis C and syphilis, all from one fingerstick blood sample. The results of this test will be available from the pharmacist about 2–4 weeks later.”

Tests are relatively quick and are conducted in a private room at the pharmacy.

In the event someone has a reactive test, they will be given a bloodwork requisition to get a confirmation test and are directly linked with a specialist physician who will provide their care.

People with a negative test can receive information about prevention services, like HIV pre-exposure prophylaxis, condoms and learn about other ways to avoid infection.

Where to go

Testing will be available in select pharmacies throughout Newfoundland and Labrador and Nova Scotia starting on Dec. 1, 2022.

Testing will begin in Alberta in January 2023.

Testing will be by drop-in or appointment.

A full list of participating pharmacies, locations and testing hours can be found on the APPROACH website.


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