Grant: HIV Implementation Science - Component 1

The high proportion of people in Canada unknowingly living with HIV suggests a failure of current testing strategies to reach a significant portion of the population. The Public Health Agency of Canada explains that the presence of this modeled phenomenon in Canada is "because of a lack of testing and/or diagnosis". We suggest that alternative approaches to increasing HIV counselling and testing uptake need to be urgently examined. Reducing the number of people who are unaware of their positive HIV status and reducing the number diagnosed late in the course of their infection requires a re-conceptualization of testing strategies and a re-envisioned approach to offering HIV counselling and testing. We propose to implement and comprehensively evaluate, from the perspectives of both personnel and differentially socially-located women and men, a model for the integration of routine, provider-initiated non-targeted HIV counseling and point-of-care testing into a Hospital Emergency Department, a community primary health services programme, and a population-based community organization. HIV counseling and testing would be routinely offered without providers needing to assess the probability of engagement, or individuals needing to acknowledge, a specific HIV-related risk behavior or practice. This strategy has the potential to reduce the experienced stigma associated with client-initiated HIV testing documented to be a significant barrier in accessing timely uptake of HIV testing; minimizes lost opportunities of raising HIV counseling and testing due to providers' inaccurate assessment of individual risk; normalizes HIV counseling and testing as part of regular care; and facilitates linkages into medical care for people testing positive. Offering these services in venues that extend beyond medical institutions and that are easily accessed by our target populations will remove many of the experienced and perceived structural barriers to accessing HIV testing.