Best practices to increase the uptake of HIV and HCV testing among people who use drugs
- Interventions that provide HIV and/or HCV testing have been offered in a variety of settings. These include community settings such as outpatient drug treatment clinics, mobile clinics, harm reduction services such as needle exchange programs, and traditional healthcare settings such as residential inpatient drug treatment programs, visits to a general practitioner, hospital stays, emergency departments, pharmacies, as well as at home with self-testing or self-collection kits.
- These different settings have implemented a variety of strategies to increase HIV and/or HCV testing among people who use drugs. Offering point-of-care testing among people who inject drugs at community-based services appears to have promising results, though outcome measures varied across studies. Incentivizing testing at community events is another strategy that can be employed to increase testing uptake.
- Different approaches, such as rapid point-of-care testing, routinized testing (where protocol is to offer all clients testing with the option to decline), and streamlined testing (a brief statement about the test is offered with the option to decline) in substance use treatment programs have all been found to be effective and feasible.
- Emergency departments (EDs) have been identified as a setting where missed opportunities for HIV and/or HCV screening occur. Numerous studies have demonstrated that ED screening programs can be successful in identifying HCV RNA positive individuals with a history of injecting drug use. Additionally, EDs can make significant contributions to the identification of new HIV cases during an outbreak among people who inject drugs.
- Community-based, targeted outreach initiatives appear to be a successful way to engage people who use drugs in HIV and/or HCV testing; studies have found that street-based outreach to recruit people who use drugs for HIV testing had high uptake, peers are able to efficiently reach individuals with a history of injection drug use for HCV testing, community outreach models build rapport with potential clients to increase HCV testing and treatment literacy prior to engagement in the HCV care cascade, and people who inject drugs are able to successfully recruit network members for HCV testing and linkage to care.
- Facilitating HIV and/or HCV point-of-care testing in pharmacies may be another way to increase screening uptake among people who use drugs. One pharmacy offering medication-assisted therapy updated their intake form to include HCV and HIV screening as part of enrollment into the treatment program.
- Some evidence illustrates that technology-based interventions (delivered via tablet or computer) may also be useful to increase HIV and/or HCV testing uptake when delivered on-site to clients of syringe exchange programs. Integrating HCV-related content into a smartphone app for individuals with substance use disorder could increase uptake of HCV screening among those who reported injection drug use and/or shared injection equipment.
- The literature also showed successful implementation of HIV and/or HCV testing strategies when facilitated by nurses or when using electronic medical record (EMR) alerts and integration.
The Ontario HIV Treatment Network: Rapid Response Service
- People who use drugs
- General HIV- population
- Hepatitis B, C
- Health Systems
- Delivery arrangements