New HIV testing guidelines now available for Ontario healthcare providers

Ontario’s new HIV testing guidelines aim to make healthcare providers aware of recent advances in HIV testing technology, which reduce the time for a definitive diagnosis from three months to six weeks. The guidelines are also designed to increase healthcare provider awareness of the symptoms of acute and chronic HIV that are often missed in routine care, and factors that contribute to increased HIV risk. The guidelines also reinforce the important role of healthcare providers in assessing HIV risk, actively offering testing to people at risk, and reducing stigma that may keep people from being tested. Goals of HIV testing The guidelines present four goals of HIV testing: 1. Find new/recent infections by recognizing the signs and symptoms of acute HIV infection and providing testing at appropriate intervals for people who report a possible recent high-risk exposure. 2. Find chronic infections by recognizing conditions most often overlooked in people with HIV who are diagnosed late (i.e., with more advanced disease). 3. Offer testing to at-risk members of populations with high rates of HIV. This is done by assessing members of these populations for factors that may increase their risk of HIV and by recommending testing when appropriate. 4. Identify people in other specific care situations who should be tested for HIV. These would include people seeking pregnancy care and those being treated for conditions that require immunosuppressive therapy (e.g., transplants, treatment with biologics for conditions such as rheumatoid arthritis). Testing options The guidelines outline three types of HIV testing available in Ontario: Laboratory-based diagnostic serology Rapid/point-of-care (POC) testing Self-tests The guidelines stress that when a person is newly infected with HIV, a window period exists during which time not everyone will have evidence of HIV infection in their blood. Until recently, this window period was three months—and that is still the case with HIV POC tests and self-tests. However, the Public Health Ontario Laboratory’s current fourth-generation tests reduce the window period for lab-based HIV diagnostic serology testing from three months to six weeks. The guidelines discuss the following in more detail: When to test people who may have had a recent high-risk exposure Which individuals to test Factors that increase HIV risk Routine testing in populations with higher rates of HIV Throughout the guidelines, various case scenarios are presented to help illustrate appropriate HIV testing and how to provide culturally-appropriate counselling. The guidelines include a one-page “Does your patient need HIV testing?” algorithm that summarizes Ontario’s HIV testing recommendations. Standards for HIV counselling and support (including guidance on referrals and follow-up), as well as resource lists for healthcare providers and patients are also provided. Reference 1. Ontario HIV Treatment Network. Ontario guidelines for providers offering HIV testing.(accessed April 13, 2023).

New HIV testing guidelines now available for Ontario healthcare providers

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