New research study aims to make sexual health testing more accessible

A new research study will allow people to access free, quick and confidential testing for HIV, hepatitis C and syphilis in participating community pharmacies. 

The study — Adaptation of Point of Care Testing for Pharmacies to Reduce risk and Optimize Access to Care in HIV, HCV and syphilis (APPROACH) 2.0 — has launched in Alberta, following launches in Newfoundland and Labrador and Nova Scotia last December.

APPROACH 2.0 seeks to fill a need in sexual health-care services. The number of people with sexually transmitted blood-borne infections is on the rise. However, many simply don’t know they have these infections, which prevents them from getting effective treatment, explains Christine Hughes, interim dean of the Faculty of Pharmacy and Pharmaceutical Sciences and the Alberta lead for APPROACH 2.0. 

“If you’re diagnosed early and get on treatment for HIV, for example, your overall trajectory in terms of your own personal health is much better. And, in the case of hepatitis C and syphilis, we have curative treatments which are available,” says Hughes.

Along with improving personal health, better access to testing could also benefit public health, Hughes notes. 

“If you don’t know your status, you can’t take measures to reduce your risk of transmission. That’s critical because there's data showing that a high proportion of HIV transmissions occur from people who don’t know that they have the infection,” she says.

Breaking down barriers

Making sexual health testing services more accessible is challenging because of numerous barriers that exist. Some are physical barriers, such as lack of access to a primary care provider, clinic or testing site, especially in rural or remote communities. Other barriers such as stigma and previous discriminatory or negative experiences in health-care settings may also dissuade people from getting tested.

“When we think of people who are less likely to access our usual health-care systems, they’re often groups that have experienced stigma or have other challenges that are well documented,” says Hughes. “We need to look at reaching people in a safe, inclusive way, but also being able to offer alternative options.”

For many who have avoided sexual health testing because of these barriers, pharmacies can provide a more appealing alternative, says Dylan Moulton, a clinical pharmacist and pharmacy manager at Medi-Drugs Millcreek, one of the pharmacies participating in the study. 

“Pharmacists are absolutely removing barriers to health-care access, especially for equity-seeking groups who don’t always feel comfortable accessing traditional health-care spaces that don’t feel safe to them,” Moulton says. 

By providing testing for syphilis, hepatitis C and HIV through this study, researchers are trying to determine how efficiently and effectively they can reach people and fill that gap in care at the community pharmacy level. 

“Sexual health is a private matter for a lot of people,” says Moulton. “Pharmacists are often seen as trustworthy health-care professionals that people feel comfortable sharing their concerns with.” 

Moulton and fellow Medi-Drugs Millcreek pharmacist Jyoti Palak are offering their services as part of the study, and recently completed the required training that all study participants must undertake. 

An inclusive, sensitive approach

In addition to completing virtual modules about the specific infections the study is screening for and the point-of-care testing methods being used, participating pharmacists receive stigma awareness training “to ensure we’re providing this care inclusively and in a trauma-informed way,” says Moulton.

They also have in-person training in which they cover additional topics, such as how to navigate potentially sensitive conversations with patients and how to take next steps when a patient tests positive for an infection. In these cases, the pharmacists will order further testing to confirm the results and directly connect the individuals with a health-care professional who can assist them in navigatingthe next stage in their care.

Participating pharmacies are offering two types of point-of-care tests to people who wish to be screened — a rapid fingerstick test or a dried blood spot test. Both tests require just a few drops of blood, obtained from a finger prick, and can be conducted in a private room at the pharmacy. 

The point-of-care tests also effectively address another barrier many people may face — needle phobia. 

“There are a lot of people who don’t get blood tests done because they’re terrified to get their blood taken,” says Moulton. “They’re often afraid to get an intravenous blood draw, but not necessarily afraid to get a finger poke, as it is quick and relatively painless.”

The rapid fingerstick test can screen for either HIV or hepatitis C and provides results within minutes. The dried blood spot test takes about two to four weeks to obtain results but can screen for all three infections at once. 

APPROACH 2.0 follows in the footsteps of the APPROACH pilot study, in which 123 rapid point-of-care tests for HIV were performed over six months in Newfoundland and Labrador and Alberta. 

“[The pilot study] was really well received from clients being tested. People were really positive about the information they received from the pharmacists, and the convenience,” says Hughes. However, many clients were seeking testing for additional infections beyond HIV, which is one of the main reasons the latest study expanded the options available for testing to include hepatitis C and syphilis, she explains.

APPROACH 2.0 will run for one year, with 17 pharmacists in eight pharmacies in Alberta participating. 

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