Public health agents want every adult having sex in BC to get HIV tests

If you’re an adult living in Vancouver or Prince George who’s had sex, chances are very good that you’ll be asked to take an HIV detection test at your next lab, hospital or medical clinic visit under Canada’s first such pilot project.

You can refuse the offer but you won’t be able to avoid the HIV testing guerrilla marketing campaign delivered via social media, bus shelters and websites starting today. The “seek and treat” program is meant to identify up to 3,500 more cases of HIV in BC.

That’s the number of adults estimated to be infected who don’t know it, since symptoms of HIV can be silent for as many as 10 years, according to public health authorities.

Under a four-year, $48-million program funded by the provincial government, family doctors are being urged to add on HIV testing for all their adult patients being sent for other types of blood tests.

Many patients recently admitted and/or treated at St. Paul’s, Mount St. Joseph and Vancouver General Hospital have been offered the tests as well. UBC Hospital patients will be included as of next year. Intensive care patients, palliative and psychiatric will not be included in the screening program.

Lab tests cost up to about $300. The initial test, if it is negative, costs between $10 and $25, depending on where it is done. If the initial screening test is positive, more tests are done to confirm the diagnosis. Lab tests done as part of routine blood work are cheaper which is why doctors are being urged to add on the HIV screening tests when ordering other tests.

The program is purposely casting a wide net as it seeks those who are outside the usual HIV risk group scope, said Dr. Reka Gustafson, medical health officer, communicable disease control, for Vancouver Coastal Health.

“No question about it, this is a big practice change. In the past, we have targeted people in high risk groups (like men who have sex with men) but now we need to go beyond that and offer tests to anyone who has ever had sex. It will not only reduce the stigma of such testing but it will also improve our early detection rates,” she said.

Even before the program ramp-up this week, hospitals and doctors were ordering more HIV tests, resulting in more cases being detected. In the months of June, July and August last year, 45 cases of HIV were detected in Vancouver but in the same months this year, there were 78.

Not all the Vancouver cases are city residents, as the data captures information based on where the prescribing doctor works, not where the patient resides.

About 200,000 HIV tests are done annually in B.C. and such blood tests have detected nearly 14,000 cases of individuals now living with HIV. Last year, there were 301 new HIV cases in B.C; three of every 1,000 tests results in an HIV diagnosis.

British research has demonstrated a cost benefit when the prevalence of diagnosis is one or two out of every 1,000 tests. “We expect our diagnostic yield be higher than that,” Gustafson said.

Detecting and treating HIV especially in its early stage helps reduce medical costs and prevent further transmission. Highly active anti-retroviral therapy (HAART) suppresses the virus to undetectable levels. B.C. research has shown that 40 per cent of those who died of HIV-related causes between 1997 and 2005 had never received the life-saving medication. Citing US Centre for Disease Control research, Gustafson said lifetime HIV treatment costs nearly $400,000 per patient, but patients diagnosed early enough in their disease require less treatment, saving the health care system up to $61,000 per patient.

About 14 per cent of people newly diagnosed have advanced disease at the time of diagnosis, which suggests they ignored symptoms or had no symptoms before they were tested.

The screening program will be evaluated for effectiveness, including cost benefits, and if it is deemed to be successful, it is expected it will become part of routine health care.