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‘seek and treat’

The pilot project’s early findings show the need to make testing for the AIDS virus routine, rather than targeted only toward those considered high-risk, officials say.

A Vancouver pilot project to routinely test hospital patients for the AIDS virus, the first program of its kind in Canada, has uncovered a surprising number of HIV-positive individuals who were previously undiagnosed.

Designed to expand testing to those not thought to be at risk of contracting AIDS, the project found 35 people with the virus during its first year of operation.

Few fit the profile of those engaging in high-risk activity, such as exchanging drug-injection needles or regularly having unprotected sex.

Several were seniors, said Julio Montaner of the B.C. Centre for Excellence in HIV/AIDS, who has spearheaded the province's landmark "Seek and Treat" program to combat AIDS.

"Neither age nor profiling would have helped us identify these people," Dr. Montaner said.

"These are people who do not fit any one of the established stereotypes, and if they had a high-risk encounter, they forgot about it, they didn't make the association."

They were identified only because of a routine AIDS test now being recommended to patients admitted to four hospitals in the Vancouver Coastal Health Authority.

Asked whether a significant number of the new HIV-positive patients were aboriginal, the community with Canada's fastest-growing rate of new infections, Dr. Montaner said that was not a feature of the group.

Patricia Daly, chief medical health officer for VCHA, said she was surprised how many patients tested positive.

"When we started, I thought we were already doing a good job testing for HIV," Dr. Daly said on Thursday. "But we've now shown that we were not doing a great job. Many who tested positive had had many interactions with the health care system when they could have been tested, but they were not. They came from all communities, all age ranges."

The pilot project's early findings show the need to make testing for the AIDS virus routine, rather than targeted only toward those considered high-risk, she said. "We have to take the stigma away from having an AIDS test."

The earlier HIV is identified, the earlier the patient can be treated and the less chance there is the virus will be passed on.

Studies in the United States have estimated that testing campaigns are cost-effective if one person per thousand is found with the virus. The rate among Vancouver hospital patients has been close to seven per thousand.

"This is huge," Dr. Montaner said. "It's not only cost-effective, it's finding people with HIV months or years before they would otherwise be found. That's good for the person and good that he or she can protect others. Everybody wins."

Under the project, patients admitted to VCHA hospitals are asked whether they mind if their routine blood work includes a test for HIV. About 94 per cent have agreed.

Dr. Montaner admitted that even he was a bit taken aback so many said yes.

"But these are people who are not suspected of being at risk. These are people like you or me, so to speak," he said. "So we have removed the finger-pointing of recommending an AIDS test because you're a bad person, and more than 90 per cent are saying, 'Sure, go ahead.'"

The four-year Seek and Treat policy aims to promote testing for the AIDS virus aggressively for all British Columbians who are sexually active.

The government recently announced an expansion of the program, which has drawn worldwide interest.

Anti-AIDS drug cocktails render the virus so weak that it is very difficult to transmit.

In British Columbia, which pioneered such treatment, the number of new HIV infections has fallen from more than 900 a year in the mid-1990s to fewer than 290 in 2011.

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