Original Title: Pertinence de l'utilisation des trousses de dépistage rapide du VIH par les intervenants communautaires au Québec

Authors' objectives: The Ministère de la Santé et des Services sociaux (MSSS) has asked the Institut national d’excellence en santé et en services sociaux (INESSS) to evaluate the relevance of adding the use of human immunodeficiency virus (HIV) rapid test kits (RTKs) by community workers to the current HIV screening services offered by the Québec health system. This request follows advocacy efforts by the Coalition des organismes communautaires québécois de lutte contre le sida (COCQ-SIDA) to the MSSS and the National Director of Public Health, seeking legislative and operational changes to allow community workers to perform HIV infection testing using RTKs at points of care, including in community organizations [COCQ-SIDA, 2022]. Although the evaluation focused primarily on RTKs, some information was also collected on the use of HIV self-tests.

Authors' results and conclusions: RESULTS (#1 THE DISEASE’S SEVERITY AND PROGNOSIS VARY GREATLY): HIV causes a slowly progressing disease that leads to death if left untreated, and whose severity and prognosis depend on the timing of diagnosis, treatment received, treatment adherence and follow-up. (#2 HIV INFECTION IN QUÉBEC REMAINS CONCENTRATED IN URBAN CENTRES AND AMONG AT-RISK POPULATIONS): Men who have sex with men (MSM) and people from countries where HIV is endemic are at the highest risk of contracting or being infected with HIV. (#3 WITH THE CURRENT VIH TESTING SERVICES AVAILABLE IN QUÉBEC, UNMET NEEDS PERSIST FOR PEOPLE AT RISK OF HIV INFECTION): Just over three-quarters (78.0%) of people newly diagnosed in 2022 had never been tested for HIV before. • Approximately 50% of PLHIV are diagnosed at a later stage and do not receive timely treatment, and nearly half of these individuals are believed to be from countries where HIV is endemic. (#4 VARIOUS TESTING, DIAGNOSIS AND TREATMENT OPTIONS ARE AVAILABLE TO HELP PREVENT AND CONTROL THE DISEASE): • To detect HIV, three categories of immunoenzymatic tests are available in Québec: laboratory tests, point-of-care RTKs and self-tests, the last of which, however, are provided at the user’s expense. • Laboratory tests are performed on a blood sample taken by venipuncture. (#5 RAPID HIV TESTING BASED ON THE USE OF RTKS BY NON-PROFESSIONALS IS COMMON PRACTICE IN SEVERAL COUNTRIES AND PERMITTED IN CERTAIN CANADIAN PROVINCES): • According to the literature, HIV RTKs are generally well accepted by health professionals, non-professionals and target populations. (#6 SELF-TESTING IS A MODALITY THAT CAN BE CONSIDERED AS A COMPLEMENT TO SCREENING TESTS): User satisfaction rates are high.

Authors' recommendations: Following the entire evaluation process and deliberation, INESSS presents the following position: Given the paucity of evidence demonstrating the effectiveness of rapid HIV testing conducted by community workers, as well as current organizational constraints limiting the operational feasibility of this screening strategy, its use is not recommended in the current context.

Authors' methods: A systematic review was conducted to document the performance, effectiveness, safety (clinical aspect) and efficiency (financial aspect) of HIV RTKs. A narrative review of the scientific and grey literature was also conducted to identify practice guides, guidelines and other policy documents setting out recommendations or positions in order to document population, sociocultural and organizational aspects, among others. Contextual and experiential data were collected from an advisory committee representing professionals active in the field and from people working in the community organizations in question. Ad hoc consultations were also conducted with stakeholders and a monitoring committee.

Project Status: Completed

Year Published: 2025

URL for published report: https://www.inesss.qc.ca/publications/repertoire-des-publications/publication/pertinence-de-lutilisation-des-trousses-de-depistage-rapide-du-vih-par-les-intervenants-communautaires-au-quebec.html

English language abstract: An English language summary is available

Publication Type: Full HTA

Country: Canada

Province: Quebec

Organisation Name: Institut national d'excellence en sante et en services sociaux

Contact Address: L'Institut national d'excellence en sante et en services sociaux (INESSS) , 2021, avenue Union, bureau 10.083, Montreal, Quebec, Canada, H3A 2S9;Tel: 1+514-873-2563, Fax: 1+514-873-1369

Contact Name: demande@inesss.qc.ca

Contact Email: demande@inesss.qc.ca

Copyright: L'Institut national d'excellence en sante et en services sociaux (INESSS)