We know that emergency departments (EDs) are often the main places where marginalization populations access healthcare. However, until our project launched in Oct 2021, rapid HIV testing was not available within the ED anywhere in Canada. If a HIV test was offered (which was not common practice), it would be sent to a public health laboratory, which meant that results were not available for 1-3 weeks. This meant that the ability to communicate results to the patient during their emergency room visit was lost, and the ability to connect them with appropriate care became incredibly challenging. Knowing that there was this lag time in receiving results, ED physicians were less likely to offer HIV testing to their patients. The goal of our project was to develop and implement an evidence-based rapid HIV testing protocol in the ED to demonstrate that HIV testing in the ED is feasible, effective and valuable.

In Canada 1 in 7 people with HIV do not know they are infected and miss key chances for treatment and prevention of spread. In Ontario, new infections are rising among indigenous people, women, youth, immigrants, and the under-housed, along with people who inject drugs and men who have sex with men. Emergency Departments (EDs) are often the main health care access point for vulnerable people, and these high-risk groups are currently less likely to get HIV tested. Prior to our project, results from HIV tests undertaken in Ontario hospitals were not available for 1-3 weeks, leading to delays in vital information for ED providers caring for acutely ill patients and limiting access for screening high risk patients. Our new rapid, accessible test in our EDs has enabled people who are most at risk and who may rarely seek medical care to have HIV testing, counseling, and linkage to specialist follow-up. During the first 11 months of pilot testing, we completed 285 tests, with 10 HIV positive persons found and 7 were new HIV diagnoses. Six of these newly diagnosed patients were connected with care, while the 7th patient moved provinces. Our project has demonstrated that rapid HIV testing in the ED is feasible, effective and valuable. We presented our initial findings through multiple presentations at the CAEP Conference in May 2023 and have multiple manuscripts being prepared. We also plan to develop an easy-to-use toolkit in order to allow ED leadership for hospitals throughout Ontario and Canada to easily implement rapid HIV testing within their own departments. We have received some additional funding from the OHTN in order to support these KT activities, finalize our evaluation of the pilot phase of this project, as well as to expand the project to an additional site in Thunder Bay. Our hope is that the findings from Thunder Bay will allow us to demonstrate that our testing protocol is relevant and feasible in different locations that have varying resources available.