Abstract
HIV testing is a core pillar of Canada's approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed. To examine current barriers and facilitators of HIV testing across key populations and jurisdictions in Canada. A systematic mixed studies review of peer-reviewed and grey literature was conducted identifying quantitative and qualitative studies of barriers and facilitators to HIV testing in Canada published from 2009 to 2019. Studies were screened for inclusion and identified barriers and facilitators were extracted. The quality of included studies was assessed and results were summarized. Forty-three relevant studies were identified. Common barriers emerge across key populations and jurisdictions, including difficulties accessing testing services, fear and stigma surrounding HIV, low risk perception, insufficient patient confidentiality and lack of resources for testing. Innovative practices that could facilitate HIV testing were identified, such as new testing settings (dental care, pharmacies, mobile units, emergency departments), new modalities (oral testing, peer counselling) and personalized sex/gender and age-based interventions and approaches. Key populations also face unique sociocultural, structural and legislative barriers to HIV testing. Many studies identified the need to offer a broad range of testing options and integrate testing within routine healthcare practices. Efforts to improve access to HIV testing should consider barriers and facilitators at the level of the individual, healthcare provider and policy and should focus on the accessibility, inclusivity, convenience and confidentiality of testing services. In addition, testing services must be adapted to the unique needs and contexts of key populations.
Highlights
The World Health Organization estimated that approximately 37.9 million people were living with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) worldwide in 2018, including about 1.7 million who were newly infected that year (1).In Canada, more than 63,000 people were living with HIV in 2016, and nearly 23,000 new cases were diagnosed between 2008 and 2017 (2).CCDR February 2021 Vol 47 No 2HIV testing and diagnosis is a critical first step in the HIV care cascade (HIV diagnosis, linkage to care, antiretroviral therapy initiation and achievement of viral suppression)
Results by key population A large number of studies focused on gbMSM (n=15) (24,32–34,36–38,44–47,50,51,53,61), reflecting the historical epidemiology of HIV in Canada
Shame associated with requesting HIV testing and responding to the pre-test questionnaire (41)
Summary
The World Health Organization estimated that approximately 37.9 million people were living with HIV/AIDS worldwide in 2018, including about 1.7 million who were newly infected that year (1).In Canada, more than 63,000 people were living with HIV in 2016, and nearly 23,000 new cases were diagnosed between 2008 and 2017 (2).CCDR February 2021 Vol 47 No 2HIV testing and diagnosis is a critical first step in the HIV care cascade (HIV diagnosis, linkage to care, antiretroviral therapy initiation and achievement of viral suppression). In 2014, the Joint United Nations Programme on HIV/AIDS (UNAIDS) Programme Coordinating Board established the 90-90-90 targets with the goal of ending the AIDS epidemic by 2020 The aim of these targets are for 90% of all people living with HIV to know their HIV status, 90% of all people diagnosed with HIV to receive appropriate antiretroviral therapy (ART) and 90% of all people receiving ART to achieve viral suppression (4,5). HIV testing is a core pillar of Canada’s approach to sexually transmitted and blood-borne infection (STBBI) prevention and treatment and is critical to achieving the first Joint United Nations Programme on HIV/AIDS (UNAIDS) 90-90-90 target. Despite progress toward this goal, many Canadians remain unaware of their status and testing varies across populations and jurisdictions. An understanding of drivers of HIV testing is essential to improve access to HIV testing and reach the undiagnosed
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