CBRC expands on successful self-testing pilot following a federal government investment
If it works, do more of it. That’s the simple principle behind the scale up of the Community-Based Research Centre’s (CBRC) HIV self-testing pilot–one that has already seen more than 8,850 self-test kits sent to 2S/LGBTQIA+ people across Canada over the past two years.
HIV self-tests, approved for use in Canada since 2020, guides a user through drawing their own finger-prick of blood to combine with three small solutions. The highly-accurate test produces a positive or negative HIV result in about one minute, prompting the user to get confirmatory bloodwork if positive. Retailing at about $35 per self-test, CBRC hopes to take the cost and other barriers out of the equation by creating an online portal for people to order tests for free.
“You don’t pay to get an HIV test from your physician, so why should you pay for this?” asks Chris Draenos, CBRC’s National STBBI Testing and Linkage Implementation Manager. “In fact, it’s probably cheaper for the public health system than what your physician would bill to do a test.”
That could be partly why the Public Health Agency of Canada (PHAC)–the department responsible for supporting the federal response to public health issues, including HIV–has provided the funds enabling CBRC to deliver these additional 15,000 self-tests. Another reason is to reach the latest UNAIDS 95-95-95 fast-track targets–a global pledge Canada has made, part of which includes 95 percent of all people living with HIV to know their status by 2025.
Right now, an estimated 1 in 10 people who have HIV don’t know it–translating into thousands of people. Without knowing your status, you can’t receive treatment and achieve viral suppression–which makes it impossible to spread the virus to others.
Because gay, bisexual and men who have sex with men continue to make up the largest proportion of new HIV infections, it’s therefore especially important for them and other members of the 2S/LGBTQIA+ community to get tested. But that’s been particularly hard to do these past few years.
“In Nova Scotia, there’ve been large swaths of time in which the lab was not accepting HIV and other STBBI samples because those tests take up the same professionals and the same machines as COVID,” says Abbey Ferguson, Executive Director of the Halifax Sexual Health Centre. “Primary care access is also pretty poor at the moment, and we haven’t been able to bounce back post-COVID as far as getting timely blood work appointments.”
Because of these and other factors–like the reality of more remote communities in Nova Scotia–Ferguson estimates it could still take weeks, or even months, for someone in her province to receive an HIV assessment through the traditional channels. “In that context, the ability to take your health into your own hands and get tested at home has a lot of value.”
That’s why the Halifax Sexual Health Centre became one of a dozen community organizations to partner with CBRC in delivering HIV self-tests in-person, in addition to CBRC’s online ordering system.
“I think it was really, really successful,” says Ferguson, whose centre hosted pop-up distribution events in places like libraries. “It gets us out where folks actually are, puts a very friendly face to our services and sets the tone of the experience you’d get at your follow-up later.”
Draenos agrees, explaining that partnerships with other organizations will continue to be a big part of distributing the self-tests.
“Community distribution of HIV self-tests are more likely to reach people who have never tested before,” he says, highlighting that a quarter of people given a self-test in-person through the pilot had never been tested before, compared to 10 percent who ordered a test online.
“Organizations are very keen to support this, but many of them don’t have stable funding. Now that we’re able to provide funding associated with self-test distribution, this is an opportunity for our community to engage with each other and have conversations about health and wellbeing.”
The importance of both mail and in-person delivery methods was just one lesson to come from delivering the previous 8,000-plus tests. Making sure the tests were properly stored away from heat, helping people interpret faulty results and making sure the right quantity of blood was squeezed into the test were other key learnings, says Draenos. But these, and other, directions can be communicated through materials sent out with the tests, as well as through a support line.
“We offer virtual peer support for self-tests from 2S/LGBTQIA+ community members through email, toll-free calling and texting,” says Draenos. “That communication also allows us to recommend other resources in STBBI care and prevention, mental health supports and harm reduction services.”
Peer support wasn’t the only thing CBRC paired with HIV self-tests. Medicine Bundles were available to Two-Spirit Indigenous people accessing self-tests in what is colonially referred to as British Columbia–a parallel project created and led by that community.
“The Medicine Bundle is where we keep our spiritual objects that we use in ceremony,” says Martin Morberg, the Two-Spirit Program Coordinator at CBRC. Including things like Bear grease, sage, cedar, tobacco ties, lavender and sweetgrass, these medicines are wrapped with HIV self-tests to nurture a more fulsome and culturally-relevant health intervention.
“It’s cultural relativism–an understanding that these western tools work, they have the science and research to back them up in regards to testing for HIV,” says Morberg. “But we also understand that Indigenous people have systems of health that are equally as valid. Indigenous worldviews of health are beyond just the physical. We are more than just our bodies, we are holistic beings. Our spirits also need nourishment when addressing our health needs.”
As with the newest batch of 15,000 HIV self-tests, CBRC has created an online portal for Indigenous people in the colonially-recognized area of British Columbia to request Medicine Bundles. Based on the popularity and positive reviews for both projects, Draenos is expecting continued high uptake.
“We’ve done all this research work, we’ve learned a lot about what works and what doesn’t and we’ve really refined our processes to make sure that we’re focusing on what matters most to our community members.”
To order an HIV self-test kit, visit here.
To order a Medicine Bundle in what is colonially known as British Columbia, visit here.