HIV treatments are a literal lifesaver and help people to live long and healthy lives, while also preventing transmission. There are also highly effective hepatitis C treatments that cure more than 95% of those living with the infection. But none of the advancements in hepatitis C and HIV treatment are being realized for the 13% of HIV-positive Canadians and 44% of Canadians with hepatitis C who don’t know their status. Testing is the first step towards connecting people to treatment, care and support, and no matter the result, it can also be the gateway to prevention services like harm reduction programs, pre-exposure prophylaxis (PrEP) and more.
Health and social service providers play a critical role in helping their clients and patients understand and access HIV and hepatitis C testing, supporting them with their results, and linking them to follow-up services. In 2021, CATIE rolled out a new course on HIV and hepatitis C testing to help service providers increase their capacity in this area. This online course helps learners develop in-depth knowledge of testing technologies and approaches, and to think about the role that all service providers play in diagnosing people with HIV and hepatitis C.
As one of the educators who facilitated this course, my colleagues and I have learned a lot about the needs and concerns of frontline service providers when it comes to testing. Below, I have shared some of our reflections from our first year of delivering this course.
All service providers have a role to play in testing
Throughout the course, we asked learners to consider their own role in testing, even when they don’t do the testing themselves. From their conversations, it became clear that service providers working in all aspects of HIV and hepatitis C prevention, treatment, care and related services can and do play a critical role in reaching the undiagnosed.
For instance, a person working in a shelter can offer residents information about testing and practical supports such as accompaniment to clinics. Harm reduction workers may be well positioned to leverage the trust they have built with their service users and connect them to a local testing partner. Whatever their role, service providers can consider how the relationships they’ve nurtured can facilitate testing, and how testing can be an entry point to prevention, care and treatment.
Service providers want more knowledge about testing
To speak confidently with service users about testing, service providers need to know the answers to commonly asked questions. But we learned that there are knowledge gaps about HIV and hepatitis C testing among all types of service providers. This includes: what tests are available and how they work, when people should get tested, and how best to refer people to and from testing services.
There is also a desire to understand more about the many elements involved in testing, including issues related to confidentiality and disclosure, pre- and post-test counselling, partner notification and consent. Knowing these elements can help service providers offer information and reassurance before, during or after a testing experience.
Service providers have knowledge to share and want to learn from and connect with each other
In all of CATIE’s courses, we provide space for service providers to learn from one another. In this course, participants across Canada shared strategies they are using to reduce barriers to testing, and helped each other think through challenges. We’ve learned about testing programs in high schools, backpack outreach testing, partnered testing events, and the countless ways that peer workers can facilitate access to testing. We’ve heard excitement about these creative approaches, but also frustration about the current limitations in participants’ communities.
While learning from and connecting to each other has always been important, it has become even more important with the isolation, burnout and grief experienced among those working on the front lines of health and social services. More than ever, we are seeing participants eager to connect with each other and learn in a collaborative manner.
More work is needed to break down the siloes of HIV and hepatitis C work
We intentionally designed this course to be focused on both HIV and hepatitis C. However, we soon learned that some (but not all!) of our partners and participants were dubious about engaging in a course that integrated testing for both of these viruses – they hoped for education on either HIV or hepatitis C testing, not both. Historically, some HIV and hepatitis C work has been siloed; this is often related to what programs are funded to do. However, we’re hearing how understanding both can better meet the holistic needs of clients.
Service providers know that many of the structural and social factors that lead to HIV or hepatitis C vulnerability are overlapping and many of the strategies used to address HIV and hepatitis C draw from similar principles. There’s value in sharing lessons across HIV and hepatitis C worlds, even if an individual’s job is focused on one or the other.
Stigma is a central barrier to HIV and hepatitis C testing
Stigma continues to have an impact on all elements of HIV and hepatitis C care, and testing is no exception. Our learners reflected on the ways that stigma creates barriers to testing, and how mitigating stigma is a strategy to facilitate access to testing. Related to stigma is the fear that testing won’t be private or confidential, and this is a barrier that we’ve heard from service providers across the country – but especially from those working in smaller and more remote communities. We’ve also heard participants share how the routine offer of HIV testing and the age-based offer of one-time testing for hepatitis C is breaking down some of that stigma by normalizing HIV and hepatitis C testing outside of traditional “risk factors”.
Since the launch of the course in spring 2021, we have been excited to see our participants share strategies and lessons learned, make connections across roles, sectors and regions, and help each other bridge knowledge gaps related to HIV and hepatitis C testing. We look forward to engaging even more service providers in the course this year, and you could be one of them. Register for our next course (it’s free!) or browse other courses offered by CATIE here.
Shelley Taylor is based in Ottawa, Ontario, where she works as a specialist in education and capacity building with CATIE. Shelley has a background in sexual health and adult education with a particular interest in knowledge exchange and the power of knowledge mobilization to create positive and lasting change. When not working, Shelley and her wife host queer dance parties and cater to every whim of their tiny geriatric dog.