Health Care Provider Testing
The vast majority of HIV tests in Ontario are performed by primary care providers, particularly family doctors. These trusted care providers are the resource that most Ontarians turn to when they are concerned that they have had an exposure to HIV. On average, 16 of every 1000 HIV tests ordered in Ontario is positive. For more data on the HIV epidemic in Ontario, visit: www.ohesi.ca
Health care providers are encouraged to:
- Test whenever a patient requests a test.
- Consider HIV testing when another sexually transmitted infection (STI) is diagnosed, particularly rectal STIs.
- Offer HIV testing three weeks, six weeks and three months* after any high-risk exposure to HIV. (See this training unit on assessing HIV risk for detail on determining a high-risk exposure.) A high-risk exposure involves practices that exchange bodily fluids with sexual or drug use partners, without effective protection, when a person’s partner may have a detectable HIV viral load. In Ontario, individuals from five specific priority populations have a higher risk of being HIV
- Consider prescribing HIV pre-exposure prophylaxis(PrEP) for patients with repeated high-risk exposures. You can learn more about PrEP prescribing at OntarioPrep.ca
- Consider Post-Exposure Prophylaxis (PEP) for any high-risk exposure within 72 hours.
Complete the HIV Serology Requisition as completely as possible; this provides vital information for Ontario’s testing programs.
Health care providers are encourage to talk to their patients about their sexual health and HIV/STI risk. This encourages patients to share information about possible exposures and to seek guidance about self protection. Guidance on performing a brief patient history and STI risk assessment and on providing patient-centred education and counselling is available as part of the Canadian Guidelines on Sexually Transmitted Infections.
Acute HIV Infection
Fifty to ninety percent of people ultimately diagnosed with HIV, have symptoms of acute HIV infection 2-4 weeks after their initial exposure. Many of these individuals may seek medical care to address these symptoms. Acute HIV infection (seroconversion illness) is most typically characterized by a mild fever, and swollen lymph nodes. Learn more.
Ontario recommends prenatal screening of all pregnant women and women considering pregnancy.
Nearly half of those diagnosed with HIV in Ontario are diagnosed late, after immune damage has begun. Physicians should be alert to signs of immune compromise in their patients and consider HIV testing as part of the diagnosis.
*Individuals presenting later than 3 weeks into the window period should be tested at the time of presentation, and at whatever other testing intervals remain, as measured from the time of exposure.