Grant: Operating Grant - PA: HIV/AIDS Bridge Funding - Health Services/Pop Hlth Stream

The number of people living with HIV/AIDS in Canada increased steadily during 2009-2012, creating an economic burden to society as a whole. An efficient way of controlling the HIV epidemic is to bring people into care early on and to prevent further transmission, which is only possible if people are aware of their HIV status. Unfortunately, about 25% of Canadians living with HIV are unaware of their status. Although HIV testing is available in Canada through health facilities, many avoid it because of privacy concerns, long waiting time, stigma and discrimination. These barriers can be partially circumvented with self-test kits, which allow people to test themselves at home, with counselling and linkage to care arranged by phone. An over-the-counter HIV self-test, designed to be used at home, has been available since 2012 in the United States, stirring the debate over the approval of a similar test in Canada. However, the potential public health impact of introducing self-tests in the Canadian context remains unknown. In this proposal, we will investigate the impact that HIV self-tests will have on detecting new cases in individuals that are unaware of their status, and the cost associated with adding self-testing as a complement to facility-based testing in Canada. A human research study to answer this question would take many years. Hence, we propose to build a mathematical model that will combine epidemiological and economic data to project the likely public health impact and the cost-effectiveness of offering a comprehensive self-testing strategy in Canada. This work will help inform and guide policymakers at federal, provincial and territorial levels regarding the introduction of HIV self-tests in Canada. The question is novel, the timing is right, and the study findings will be of significance for Canada and similar settings worldwide.