Spotlight Campaign – Ontario new testing guidelines

Introduction

In April, the Ontario Guidelines for Providers Offering HIV Testing was published by the OHTN in collaboration with the Ontario Ministry of Health and other key partners. Leading up to World AIDS Day (December 1), the OHTN has partnered with Toronto HIV/AIDS Network (THN) and Ontario AIDS Network (OAN) to unpack key aspects of the Guidelines relevant to front-line organizations who are part of the testing referral pathway.

Over the next five weeks, we’ll share posts that explain the Testing Window, the 3Ps of HIV Risk, the difference between Acute and Chronic HIV symptoms, the importance of culturally-responsive testing, and the Status Neutral Approach to testing.

Your staff are critical in supporting access to testing. These materials have been developed for you and your staff to use. You’re invited to share these posts, use them for discussion and education with staff and volunteer teams, and to distribute them through your own social media and other digital platforms.

If you would like original copies of these graphics to share to your networks, please Contact the OHTN https://hivtestingontario.ca/

To learn more about Ontario’s updated HIV testing guidelines, visit: www.hivtestingontario.ca

Five things you need to know About Ontario's HIV testing Guidelines — #1Introduction-rectangle

Window Period

The window period of an HIV test refers to the time it takes before a test can confirm or rule-out HIV infection after a given exposure. The updated Ontario Guidelines for Providers Offering HIV Testing outlines a reduced window period for laboratory-based testing. So, what is the new window period?

Until recently the window period for a lab-based test was three months. This meant a person would have to wait three months from the time of a potential exposure to HIV to rule-out an infection (though, a positive test could sometimes come back sooner). Today, thanks to advances in technology, the window period for lab-based HIV diagnostic serology testing is only six weeks.

Note: the window period is still three months for POC and self-tests.

#2Window period-square
Laboratory Based testing can rule out HIV within 6 weeks of exposure.

The 3Ps of HIV Risk

The ‘3Ps’ assessment, outlined in the updated Ontario Guidelines for Providers Offering HIV Testing, helps identify an individual’s risk of HIV. A person is considered at high-risk if all three ’P’s’ have occurred. So, what are the ‘3Ps’?

Partner(s): The client’s sexual partner(s) are HIV-positive and viremic OR of unknown HIV status AND from a population with a high prevalence of HIV.

Practices: The client’s practices include anal or vaginal sex, and/or injecting drugs.

Protection: There may have been a gap, including no or delayed condom use, a removed or broken condom, or the sharing of injection drug equipment.

The 3Ps of HIV Risk – #3A-landscape
The 3Ps of HIV Risk. A high-risk sexual exposure can be identified by three factors: Partners; Practices; Protection.

The 3Ps of HIV Risk. - Partners - rectangular - X (twitter) LinkedIn — The 3Ps of HIV Risk – Partners -#3B-landscape
The client's sexual partner(s) are HIV- positive and suppressed viral load OR of unknown HIV status AND from a population with a high prevalence of HIV

Practices - Risk of HIV - rectangular X (twitter) LinkedIn — The 3Ps of HIV Risk – Practices – #3C-landscape
Practices - The Client's Practices include anal and or vaginal sex, and /or injecting drug

Protection - Risk of HIV - rectangular X (twitter) LinkedIn — The 3Ps of HIV Risk – Protection – #3D-landscape
Protection - There may have been a gap, including no or delayed condom use, a removed or broken condom, or the sharing of injection drug equipment.

Practices - Risk of HIV - square - Instagram, Facebook — The 3Ps of HIV Risk – Practices – #3B-square
Practices - The Client's Practices include anal and or vaginal sex, and /or injecting drug

The 3Ps of HIV Risk. - Partners - square, Instagram, Facebook — The 3Ps of HIV Risk – Partners – #3C-square
The client's sexual partner(s) are HIV- positive and suppressed viral load OR of unknown HIV status AND from a population with a high prevalence of HIV

Protection - Risk of HIV - square - Facebook, Instagram — The 3Ps of HIV Risk – Protection – 3D-square

Culturally-responsive testing

There are subtle but impactful ways to adapt your HIV test counselling to a client’s culture. But why is this important?

Stigma operates differently in different communities and cultures. A sexual behaviour that’s commonplace in one culture may be stigmatized in another. A provider evaluating a client for testing should consider how comfortable that person is talking openly about their risk factors, including the kinds of sex they have and with whom, or whether they use drugs. Understanding cultural difference and being sensitive to it is a good first step to building a trusting relationship with a client in a short amount of time.

Training is being developed to support providers in better understanding how cultural difference can present barriers to testing. As well as ways to make HIV test counselling more culturally responsive, so your clients feel safe identifying their risks and getting tested if they need it.

What is culturally-responsive testing - square- Insta, Facebook — Culturally-Responsive HIV testing #4A-square
What is culturally-responsive testing?

Stigma #4B-square
Stigma operates differently in different communities

Talking about sex and substance use #4C-square
Some people are less comfortable talking about their sexual behaviours or drug use.

Training is being developed – #4D-square
Training is being developed to understand cultural barriers

What is culturally-responsive testing - LinkedIn Twitter — Culturally-Responsive HIV testing #4A-rectangle
What is culturally-responsive testing?

Stigma #4B-rectangle
Stigma operates differently in different communities

Talking about sex and substance use 4C rectangular — Talking about sex and substance use #4C-rectangle
Some people are less comfortable talking about their sexual behaviours or drug use.

Training is being developed #4D-rectangle — Training is being developed – #4D-rectangle
Training is being developed to understand cultural barriers

Acute vs. Chronic HIV Symptoms

The updated Ontario Guidelines for Providers Offering HIV Testing emphasizes the importance of detecting undiagnosed HIV. While a diagnosis should always be left up to a trained clinician, other health care workers might have the opportunity to recommend HIV testing to someone exhibiting symptoms. So, what are the symptoms?

Acute HIV symptoms can be detected early on as they typically present within two to four weeks after exposure. Some symptoms include, fever, fatigue, and/or rash. As the infection advances, an individual may experience Chronic HIV symptoms, including unexplained weight loss, shingles, and/or recurrent swollen lymph nodes.

Acute vs. Chronic HIV Symptoms #5A-rectangle
Acute vs. Chronic HIV Symptoms

Acute HIV symptoms - #5B-rectangular — Acute HIV symptoms – #5B-rectangle
Acute HIV symptoms

Chronic HIV Symptoms -#5C-rectangle
Chronic HIV Symptoms -

Acute vs. Chronic HIV Symptoms #5A-square
Acute vs. Chronic HIV Symptoms

Acute HIV symptoms – #5B-square
Acute HIV symptoms - #5B-square

Chronic HIV Symptoms - #5C-square — Chronic HIV Symptoms – #5C-square
Chronic HIV Symptoms -

What is the Status Neutral Approach to Testing?

The updated Ontario Guidelines for Providers Offering HIV Testing adopts a “status neutral” approach to testing. This means that testing is treated as an entry point to care regardless of whether the test comes back positive or negative. So, how does this work?

A person who receives a positive test result from a lab-based test should be connected with treatment services as soon as possible, ideally within 72 hours of the diagnosis. A positive test result from a point-of-care or self-test should trigger confirmatory testing from a lab-based test, which can affirm the result.

A person who receives a negative test result, and who is at ongoing risk, should be connected with prevention services and counseled on Pre-Exposure Prophylaxis or “PrEP.”

Status Neutral - 6A - rectangular 1200x630 — Status Neutral Approach #6A-rectangle
What does status neutral approach to testing mean?

Connection to care - 6B rectangular - twitter. LinkedIn — Linkage to care #6B-rectangle
Linkage to Care pathways

Status neutral approach -6c - rectangular LinkedIn, twitter — Status neutral approach – #6C-rectangle
A status neutral approach to HIV testing is treated as an entry point to care regardless of its outcome. The Client needs are accessed, and they're linked to appropriate care and services whether their results are positive or negative.

Status Neutral - 6A - Square, Insta, Facebook — Status Neutral Approach#6A-square
What does status neutral approach to testing mean?

Connection to care - 6B - square insta, Facebook — Status Neutral – Connection to care #6B-square
Linkage to Care pathways

Status neutral approach -6c- square - — Status neutral approach -#6C-square
A status neutral approach to HIV testing is treated as an entry point to care regardless of its outcome. The Client needs are accessed, and they're linked to appropriate care and services whether their results are positive or negative.

Spotlight Campaign – Ontario new testing guidelines

Spotlight Campaign – Ontario new testing guidelines

Introduction

#1Introduction-rectangle

#1Introduction-square

Window Period

#2Window period-square

#2Window period-rectangle

The 3Ps of HIV Risk

The 3Ps of HIV Risk – #3A-landscape

The 3Ps of HIV Risk – Partners -#3B-landscape

The 3Ps of HIV Risk – Practices – #3C-landscape

The 3Ps of HIV Risk – Protection – #3D-landscape

The 3Ps of HIV Risk – #3A-square

The 3Ps of HIV Risk – Practices – #3B-square

The 3Ps of HIV Risk – Partners – #3C-square

The 3Ps of HIV Risk – Protection – 3D-square

Culturally-responsive testing

Culturally-Responsive HIV testing #4A-square

Stigma #4B-square

Talking about sex and substance use #4C-square

Training is being developed – #4D-square

Culturally-Responsive HIV testing #4A-rectangle

Stigma #4B-rectangle

Talking about sex and substance use #4C-rectangle

Training is being developed – #4D-rectangle

Acute vs. Chronic HIV Symptoms

Acute vs. Chronic HIV Symptoms #5A-rectangle

Acute HIV symptoms – #5B-rectangle

Chronic HIV Symptoms -#5C-rectangle

Acute vs. Chronic HIV Symptoms #5A-square

Acute HIV symptoms – #5B-square

Chronic HIV Symptoms – #5C-square

What is the Status Neutral Approach to Testing?

Status Neutral Approach #6A-rectangle

Linkage to care #6B-rectangle

Status neutral approach – #6C-rectangle

Status Neutral Approach#6A-square

Status Neutral – Connection to care #6B-square

Status neutral approach -#6C-square

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