POC Testing Experience at Hassle Free Clinic

1
POC Testing Experience at Hassle
Free Clinic
2
Who Are We?

• Hassle Free is a community-based collectively-run
  agency providing medical and counselling services
  in all areas of sexual health.
• We began offering HIV education and prevention
  counselling in 1983 in response to the onset of
  the HIV/AIDS crisis.
• In 1985, when HIV testing became available, we
  began offering anonymous testing to our clients.
  We offered this service illegally for seven
  years.

3

• In 1992 we were involved in drafting the first
  provincial AT guidelines which largely referenced
  our experiences and protocols.
• We have over 34 years of experience in the sexual
  health field and a 23 year history of HIV
  testing.
• Hassle Free Clinic is currently the busiest AT
  HIV testing site in Canada with 5,201 tests
  performed in 2007. As for non HIV related sexual
  health service we had 16,449 client visits in
  2007.

4
History of Rapid Test

• First rapid POC test was approved by Health
  Canada in March of 2000
• First Class IV medical device approved for point
  of care use
• Recalled in April of 2002
• BioLytical Industries ran extensive clinical
  trials for a new device, culminating in its
  approval by Health Canada in October 2005

5
Rapid Point of Care Test

• Approved for use by health care professionals
  only -- this definition varies from province to
  province
• In Ontario, that means physicians, midwives and
  nurse practitioners can order HIV tests
• Not for home testing, or home collection
• Health Canadas mandate is to assess the device
  based only on technical competence, not impact

6
Standard vs. Rapid POC

• Clients always have, and should have, a choice
  but can only choose one
• Both must have pre and post test counselling
• Standard test a venous sample is taken, sent to
  the lab where an EIA is performed. If its
  negative, they send us back the result. If the
  EIA is positive, they go on to do confirmatory
  testing before they send us the result. The
  client returns to the clinic in 2 weeks to get
  their result.
• Rapid POC test a finger prick, the transfer the
  blood into the vial
• The test is performed out of the room, with the
  result available in about 2 minutes
• If negative, give client result post test
  counselling
• If reactive, give client result, obtain informed
  consent draw venous blood sample for
  confirmatory testing at the lab post test
  counselling ( discuss disclosure/supports, offer
  waiting-time support if appropriate, review
  medical, social and legal supports, reinforce
  safer-sex/harm reduction)
• Client returns for lab result in about 1 week,
  more post-test counselling

7
Sensitivity Specificity

• 99.6 Sensitivity 99.3 Specificity
• Sensitivity refers to the proportion of people
  with disease who have a positive test result.
• Specificity refers to the proportion of people
  without disease who have a negative test result.

8
Pre-Test Counselling Should include a discussion
about

• The benefits and risks of HIV testing
• Timing of testing and the window period
• Testing options (AT, nominal, non-nominal)
• HIV 101
• An assessment of the clients risks and reasons
  for testing
• Ways to prevention from infection or re-infection
• through information and support
• The meaning of the test results
• Preparing for a positive result
• Informed consent to be tested

9
Post-Test Counselling Should include the
following

• Always done in person
• Communication of the test results. Review window
  period
• Review the importance of harm reduction and
  prevention methods as appropriate
• Review strategies for staying negative
• Review what the result means (or doesnt mean)
  with the client
• Refer client for medical treatment and follow-up
  care and support

10
Hassle Frees Experience

• Between May 15 and December 31, 2006, we
  completed 2,893 test overall with 2,632 (90)
  choosing rapid POC tests
• We also conducted a client satisfaction survey
  for the first three months of our pilot. Of the
  400 respondents, 98 of them reported overall
  satisfaction with the rapid POC testing
• POC has become the preferred testing method for
  our clients with over 95 choosing this method
  over standard lab testing
• POC has also become the preferred testing method
  for the staff at Hassle Free Clinic. Not only
  does the POC test give an immediate result it
  allows for continuity with the client an
  important component in the client/counsellor
  relationship

11
Benefits

• No waiting. This reduces anxiety and means only
  one visit for negative testers
• Higher client satisfaction (HF Studies)
• Everyone gets their test results (though AT test
  sites have higher rates of return)
• Increases access, especially in non-urban
  settings, and allows communities to set up their
  own programs

12
Benefits contd

• Potential to increase uptake in testing though
  there is some concern about appropriate testing
  i.e. reaching priority populations, not feeding
  into the HIV anxious
• Potential to serve rural/remote communities where
  people must travel for health care and return
  results

13
Summary

• HIV Rapid Point of Care Tests are here to stay
• High degree of client satisfaction with rapid POC
  tests, with both uptake and outcomes
• As experienced testers, it is up to us to work
  toward making these tests available in
  appropriate testing sites