HIV Information for Health Care Providers

Before 2021 the Human Immunodeficiency Virus (HIV) incidence rate for Northwestern Health Unit’s (NWHU) catchment area had generally been lower than that of the province of Ontario; 4.1 per 100,000 NWHU 2013-2021 compared to 5-6 per 100,000 in Ontario 2012-2022.

NWHU incidence rates were 12.3 per 100,000 in 2022, and 23.3 per 100,000 in 2023. The 2022 rate was a 10-year high, and that nearly doubled in 2023. Although the increase in incidence rate affects Kenora there is increased risk for other communities. The main risk factors are drug use, homeless/under-housed, sharing drug use equipment, and not using condoms; see details in the epi report.

Case and contact follow-up for HIV

100% of HIV cases report to NWHU are followed up by a NWHU Public Health Nurse (PHN) who liaises with front line health care providers to facilitate and prompt:

• Case management, including connection to supportive services that will increase a client’s ability to adhere to a care plan, such as housing, transportation, and healthcare
• Testing
• Contact tracing, locating contacts, and facilitating access to testing
• Treatment
• Development of a long-term care plan to include health and social supports

For cases diagnosed in 2023:

• 89.5% are aware of their diagnosis and have access to care; 10.5% are thought to be out of province and cannot be located in NWHU area
• Since diagnosis, and initiation of care 6% of cases under care have left the jurisdiction
• Of those remaining in the geographic area and under care, 100% are known to have care plans in place including treatment

Actions for health care providers

Actions for health care providers include:

• Educate the client on prevention
• Encourage testing when indicated
• For all STBBIs, gather detailed information to contact the case and those exposed
• Consider PrEP and PEP
• Facilitate treatment

Testing for HIV

• Point of Care testing is available at the NWHU
• NWHU can support other health care agencies in setting up point-of-care testing
• www.hivtestingontario.ca includes Ontario Guidelines for Providers Offering HIV testing, including getting set up to receive POC test kits free of charge
• Further information and guidance PHAC HIV Screening and Testing Guide

Treatment of HIV

• Ontario HIV Treatment Network
• Ontario Guidelines for Providers offering HIV Testing – HIV Testing Ontario 
• https://www.ohtn.on.ca/rapid-response-effectiveness-uptake-and-delivery-of-non-occupational-hiv-post-exposure-prophylaxis-pep/
• HIV pre-exposure prophylaxis (PrEP) in Ontario, 2021 – The Ontario HIV Treatment Network (ohtn.on.ca)

Pre-exposure prophylaxis (PrEP)

Pre-exposure prophylaxis (PrEP) is indicated for those who are not yet infected but have ongoing risk. 

Guidelines can be found in the Canadian guideline on HIV pre-exposure prophylaxis and nonoccupational postexposure prophylaxis; indications include:

• People who inject drugs if they share injection drug use equipment with a person with a non-negligible risk of HIV infection
• Men who have sex with men who report condomless anal sex within the last 6 months and who have
  • Infectious syphilis
  • Recurrent use of nonoccupational postexposure prophylaxis (more than one use)
  • An ongoing sexual relationship with an HIV-positive partner with a risk of transmissible HIV
  • Other high-risk criteria (details at the link)
• Heterosexual, condomless vaginal or anal sex where HIV positive partner has risk of transmissible HIV

Non-occupational post-exposure prophylaxis (PEP)

Non-occupational post-exposure prophylaxis (PEP) is indicated for individuals in emergency situations and is not intended for regular use. PEP can be considered when there is greater than a negligible to low risk of HIV acquisition. You can find further details by referencing Effectiveness, uptake and delivery of non-occupational HIV post-exposure prophylaxis (PEP).

Additional treatment resources

Some additional treatment resources include:

• https://www.ohtn.on.ca/rapid-response-awareness-accessibility-and-uptake-of-pre-exposure-prophylaxis-among-cisgender-and-transgender-women-at-risk-of-hiv-infection/
• https://www.ohtn.on.ca/prep-for-cisgender-women-a-guide-for-healthcare-providers/

Prevention of HIV

• Harm reduction supplies including single-use needles are key, given the risk factors specific to NWHU area
• Condoms, and dental dams, are available free of charge at NWHU

Need more information?