Innovation key to tackle HIV crisis in province

Testing by pharmacists eases access to treatment, says Susanne Nicolay.

Our province has the unfortunate distinction of having the highest rates of HIV infection in Canada, a statistic that has been oft repeated for some time. Much has been said about the challenges facing those living with HIV in Saskatchewan, as well as the tools and resources available to health-care workers to combat this ongoing struggle. Before we can examine the approach, let’s first understand where we compare to the rest of Canada.

A deeper dive into the statistics tells the bigger story. The United Nations Programme on HIV and AIDS (UNAIDS) developed its 90-90-90 target for ending the AIDS epidemic. The goal set for 2020 was that 90 per cent of people living with HIV would be aware of their status; of those diagnosed with HIV, 90 per cent would be on antiretroviral treatment; of those on antiretroviral treatment, 90 per cent would be virally suppressed. Data released last year for 2016 shows that overall, Canada was at 86-81-91, while the most recent stats for Saskatchewan show the province at 69-78-79.

Given these jarring numbers, we must push ourselves to ask how we as a province are not meeting or near to meeting any of these important objectives. Clearly the current opportunities for individuals living with HIV to get tested and to know their status is not serving those who are in need of it. Before care and treatment options can begin or be discussed, we must address the lack of equitable access to HIV testing, including the offer of HIV testing.

New innovative ideas to tackle these ongoing challenges will be the key for success. I have been fortunate to work with a team of dedicated professionals on a pilot project in downtown Regina that enables individuals to receive rapid, point-of-care HIV testing at their local pharmacy. This pilot has been supported through a grant from Viiv Healthcare Canada.

Not only does this pilot offer testing to any of the pharmacy clientele who attend the pharmacy for services, but it also endeavours to reach those who may be disproportionately affected by HIV. It reduces the stigma that some may face and provides an easier avenue for testing. Individuals should be able to access care as it suits their needs, in particular those with more easily accessible health providers.

Pharmacists have not traditionally been able to offer testing for HIV in Saskatchewan; however, they are wellplaced to do this. Pharmacists provide an important link for people living with/at-risk for HIV and may facilitate access to HIV testing and reinforce rationale to know one’s HIV status. They, in fact, may be the provider that some clients are most comfortable with/whom they see most regularly.

The success in a short time with only one location has been evident; testing is reaching a new subset of individuals who may be at risk of HIV and who do not know their status.

Empowering pharmacists to offer these services has already proven invaluable. For example, many pharmacists across the province who dispense methadone for those undergoing opioid substitution therapy may also dispense antiretrovirals to people living with HIV; an effective tool in reaching those who may not be receiving timely medical treatment.

By enabling interested pharmacists in certain regions of the province to administer point-of-care HIV testing, and supporting the broader expansion of this model to reach a greater number of individuals who don’t know their status, we can better work towards meeting the UNAIDS targets while delivering better care to our residents. Out-of-thebox thinking that adds more options for people to know their status will be key in this ongoing struggle.

Susanne Nicolay is the clinic and project co-ordinator with Wellness Wheel and part of the Indigenous Wellness Research Community Network.

Individuals should be able to access care as it suits their needs, in particular ... more accessible health providers.