A pilot program used pharmacists to deliver rapid point-of-care (POC) HIV testing in community pharmacies in Toronto and Ottawa. Pharmacists provided pre- and post-test counselling to individuals and linkage to confirmatory testing if POC test results were reactive (positive). The majority of the participants in the pilot program identified as male (81.3%), with 69.8% of males identifying as gay, bisexual or a man who has sex with men (gbMSM). The program was able to reach first-time testers, with 18.7% of all Toronto-based participants (data unavailable for testers at the Ottawa site) reporting that they had not been tested for HIV previously. There were six reactive tests found during a 12-month study: five were new HIV diagnoses and one was a previously known diagnosis.
Program description
This pilot program used pharmacists to deliver POC HIV testing in Toronto and Ottawa. Pharmacies that participated in the program (one in each city) had a history of serving LGBTQ+ communities and experience in discussing HIV treatment with people.
Since HIV testing is outside the scope of practice for pharmacists in Ontario, pharmacists were able to offer testing under a medical directive provided by a local physician. Local physicians also signed memoranda of understanding to provide rapid linkage to confirmatory testing and care for those who received a reactive POC test result. Pharmacists were provided with training on how to perform HIV POC testing and report results to participants (i.e., how to deliver pre- and post-test counselling and discuss results with participants).
Pharmacies offered POC HIV testing at scheduled times through either appointments or scheduled walk-in hours. The program had significant media coverage when launched that demonstrated the use of the POC HIV test and may have contributed to program awareness and participation. Individuals seeking a test could ask pharmacists verbally for a test or pass a written request to the pharmacist. Pharmacists asked people to complete an eligibility form. Eligibility criteria included:
- being 18 years or older
- not having previously received a positive HIV test result, been told they had HIV, or be taking HIV medications
- not taking pre-exposure prophylaxis (PrEP)
- agreeing to a brief pre-test counselling in either English or French
Eligible people were taken into a private testing room where the pharmacist filled out a requisition form and provided pretest counselling. The program used the INSTI HIV-1/HIV-2 POC HIV antibody test, which requires a drop of blood from a finger prick. Results were available within minutes, and the average length of the appointment was 15 to 20 minutes. A reactive (positive) POC HIV test is not considered a final diagnosis, and a confirmatory test conducted through a laboratory with a blood draw was required for any reactive tests.
For people with a nonreactive (negative) POC HIV test result, the pharmacist shared the result with the person and provided post-test counselling, sexual health resources and a referral for PrEP or other services if needed or requested. If someone tested within the window period (within three months of possible exposure) they were invited to return for testing at three weeks, six weeks and three months.
For people with a reactive test result, the pharmacist linked them to an HIV physician for confirmatory HIV testing. The physician’s clinic staff then contacted the person if the confirmatory test results came back positive to book an appointment with the physician.
Results
Between November 29, 2019, and November 30, 2020, 835 tests were performed in Toronto and between January 6, 2020, and September 25, 2020, 141 tests were performed in Ottawa, for a total of 976 HIV POC tests. Participants could have received multiple tests during the study period; each test is counted as a separate test or person in the results. According to the requisition forms completed before the test, 908 participants (93.0%) identified their reason for testing as “routine.”
Demographic characteristics
The requisition form collected information on race, which was available for 971 participants:
- 352 (36.3%) people identified as White
- 205 (21.1%) people identified as Southeast Asian
- 122 (12.6%) people identified as Black
- 8 (0.8%) people identified as “other,” which included mixed ethnicity
There were 794 people (81.3%) who self-identified as male and 173 people (17.7%) who self-identified as women (including trans and cisgender women). Of those who identified as male, 554 (69.8%) identified as gbMSM.
Testing outcomes
Of the 976 tests performed, 895 (91.7%) test results were nonreactive and outside the window period, 75 (7.7%) were nonreactive and in the window period and 6 (0.6%) were reactive. Although linkage to care outcomes were outside of the scope of this study, it is known that all six people with a reactive test result were successfully linked to confirmatory testing within a few days of receiving their results. Five of the six people with reactive test results had confirmed new diagnoses and were gbMSM; the other person had a known diagnosis.
At the Toronto location, 156 testers (18.7%) reported that they were first-time testers. Among first-time testers, 33 were women (19.0% of women), 39 were heterosexual men (16.7% of heterosexual men), 32 were gbMSM (5.8% of gbMSM) and nine were African, Caribbean and Black (ACB) people (6.7% of ACB people). There were 36 people (4.3%) with an unknown testing history (the numbers of individuals with an unknown testing history among ACB people and people born in countries where HIV is endemic were too small to report).
Reasons for testing, testing satisfaction and costs
A total of 265 post-test survey results were available. Results showed that 96.3% of those surveyed were satisfied with their experience of pharmacy POC HIV testing. The reasons that they chose to receive HIV POC testing at a pharmacy included:
- wanting to know their test results immediately (71.0%)
- trust for pharmacists (52.8%)
- the pharmacy’s convenient location to the person’s home or work (41.9%)
- convenience for the participants’ schedules (40.7%)
- pharmacy testing was discreet/confidential (32.2%)
Most participants reported that they would be willing to pay between $10 and $25 for a HIV POC test at a pharmacy. The participating pharmacy sites agreed that a possible fee for service would range from $25 to $30 per test, covering the pharmacist’s time (approximately 15 minutes per test), supplies and cleaning products, personal protective equipment (PPE) and promotional materials.
Implications for service providers
This study demonstrates that providing HIV POC testing in pharmacies is a feasible and acceptable approach to HIV testing. It also shows that pharmacists can play an important role in the delivery of HIV testing services, which is consistent with other studies that have looked at pharmacists providing HIV POC testing in other parts of Canada (e.g., the APPROACH study).
Providing POC testing in pharmacies provides increased convenience and accessibility for clients, as reported in the study. It expands the delivery of testing locations and may allow service providers to reach more people. The program was able to reach first-time testers, the greatest number of whom were women, indicating that this may be an effective approach to engaging this population in the HIV cascade. The program was also able to reach the populations most affected by HIV (e.g., gbMSM, ACB people) and provide a method of routine HIV testing within the community, which was associated with high levels of satisfaction among users.
Related resources
Pharmacist-provided HIV point-of-care testing – evidence brief
The HIV testing process – fact sheet
HIV testing technologies – fact sheet
Reference
Winkelman S, Inamdar G, Kesler M et al. Pharmacist-delivered HIV point-of-care testing in Ontario: Lessons learned from the GetaTest pilot. Canadian Pharmacists Journal. 2022;155(6):309-14.