Health care provider resources

Important announcements

• 2022 - Pre-Exposure Prophylaxis is now available virtually to Northern Health residents through the BCCDC's TelePrEP program. For more information see Pre-Exposure Prophylaxis (PrEP) for HIV.
• 2018 - Pre-Exposure Prophylaxis is now available to those at high risk. See the BC Centre for Excellence in HIV/AIDS “HIV Pre-Exposure Prophylaxis (PrEP) guidelines” for more information, including the necessary prescription forms.
• 2014 - BC releases new HIV testing guidelines (PDF) for health care providers to encourage all adults in the province to get tested.
• 2011 - The BC Centre for Excellence in HIV/AIDS presents their therapeutic guidelines, which are constantly monitored and regularly updated.

Testing

• HIV in family practice - UBC Continuing Professional Development 
• HIV informed consent form for patients (PDF) - Northern Health
• HIV testing brochure for patients (PDF) - Northern Health
• HIV testing guidelines for the province of British Columbia (PDF) - Office of the Provincial Health Officer

Clinical care

• Care provider practice support contact list (PDF) - Northern Health
• Determining fibrosis stage for the treatment of chronic hepatitis C (PDF) - Government of BC
• HCV guidance: Recommendations for testing, managing, and treating hepatitis C - American Association for the Study of Liver Diseases (AASLD) and the Infectious Diseases Society of America (IDSA)
• HIV - Clinical care options
• NH Specialized Support Team
  • Referral form to Northern HIV/HCV Specialized Support Team (PDF) - Northern Health

Medications

• HEP drug interaction checker - University of Liverpool
• HIV drug interaction checker - University of Liverpool
• HIV Pre-Exposure Prophylaxis (PrEP) guidelines - BC Centre for Excellence in HIV/AIDS
• Special authority request forms - Government of BC

General

• About HIV: Clear and reliable information on all aspects of HIV - NAM aidsmap
• AIDS education and training center program - Health Resources and Services Administration (HRSA)
• British HIV Association (BHIVA)
• Canadian AIDS Treatment Information Exchange (CATIE)
• Centers for Disease Control and Prevention (CDC)
• Healthcare resources - BC Centre for Excellence in HIV/AIDS
• International Antiviral Society (IAS-USA)
• The British Columbia Hepatitis Testers Cohort (BC-HTC) - UBC Centre for Disease Control
• Understanding HIV/AIDS - U.S. National Library of Medicine

You play a key role in supporting patients who have HIV. HIV is a virus that uses the human immune system (specifically CD4 cells) to replicate. This weakens immune function and can lead to many opportunistic infections. A prescribed combination of antiretroviral medications (sometimes referred to as an HIV cocktail) can slow disease progression and prolong survival by decreasing viral replication. This regimen is specifically chosen by incorporating the individual’s medical history, resistance patterns or genetic predispositions to optimize activity against the virus and to minimize toxicities for the patient.

Important information

• Treatment for people living with HIV and HCV is publicly funded in BC. The Drug Treatment Program (DTP) covers HIV medications, and HCV medications are funded through Special Authority as long as the patient is enrolled in Fair PharmaCare.
• Treatment involves three or more antiretrovirals. There are various classes of antiretrovirals currently available. Visit the BC Centre for Excellence in HIV/AIDS web site for more information.
  • Nucleoside/ nueleotide reverse transcriptase inhibitors (NRTIs) such as zidovudine (AZT), lamivudine (3TC), tenofovir and abacavir;
  • Protease inhibitors (PIs) such as atazanavir, lopinavir, and ritonavir;
  • Non-nucleoside reverse transcriptase inhibitors (NNRTIs) such as nevirapine and efavirenz;
  • Fusion inhibitor enfuvirtide (Fuzeon) injection;
  • Entry inhibitor maraviroc;
  • Integrase inhibitor raltegravir.
• Adherence is the most important factor in HIV treatment success. Missing doses (i.e. entire days or not taking all pills) can lead to resistance and further complicate treatment choices.
  • All or Nothing Rule – the prescribed antiretroviral regimen must be given in its entirety to ensure the virus is being treated adequately. Even if only ONE of the medications is missing, then none of the other meds should be given. This will minimize opportunities for resistance.
  • Timing – Ideally, it is best to have patients take their pills around the same time each day to create a routine and ensure even drug levels; however, if they are late, it is ok to take a daily dose as soon as they remember within the same day. Do not double doses to catch up.
• Resistance
  • The HIV virus can change into a different form, which is not easily controlled by the current regimen. Cross-resistance may also result in the virus becoming resistant to other medications the patient has never taken before but might need in the future. Resistance can arise from poor adherence, long-term use of the same regimen or contracting a resistant virus from a new source. The doctor can order blood tests (aka genotyping) to confirm viral resistance to specific medications.
• Side effects
  • Do not suggest stopping HIV medications in response to side effects. Always ask the patient to consult with the doctor or HIV pharmacist before stopping medications. Call the outpatient pharmacist at St. Paul’s Hospital. The pharmacist can give advice on how to manage side effects or how to decrease the chances of HIV resistance.
• Drug interactions
  • Prescription and non-prescription medications, herbal products and street drugs can interact with HIV medications. Consult with the outpatient pharmacy at St. Paul’s Hospital to ensure drug interactions with antiretrovirals are avoided or managed appropriately.

Resources

• A drug chart for pharmacists (PDF) - Windsor Regional Hospitals (WRH)
• Antiretroviral drug interactions with non-prescription medications (PDF) - BC Centre for Excellence in HIV/AIDS
• ARV drug safety alerts - BC Centre for Excellence in HIV/AIDS
• HEP drug interaction checker - University of Liverpool
• HIV drug interaction checker - University of Liverpool
• NH Specialized Support Team - Northern Health
• Resources for community pharmacists - BC Centre for Excellence in HIV/AIDS
• St Paul’s Hospital Outpatient Pharmacy Hotline 1-888-511-6222

• Canadian Association of Nurses in HIV/AIDS Care (CANAC)
• NH Specialized Support Team
  • Referral form to Northern HIV/HCV Specialized Support Team (PDF) - Northern Health

• Canadian Aboriginal AIDS Network (CAAN)
• Care Provider Practice Support Contact List (PDF) - Northern Health
• Chee Mamuk (Indigenous Health) - BC Centre for Disease Control (BCCDC)
• CIHR Canadian HIV Trials Network - The CTN
• NH Specialized Support Team
  • Referral form to Northern HIV/HCV Specialized Support Team (PDF) - Northern Health

Northern Health (NH) has developed a process to support NH programs including training modules and clinical practice standards. To provide DBST, teams must:

• Complete the point of care and DBST application
• Have an ordering provider (NP or physician only at this time) who will be responsible for requisitioning the tests and following up on results
  • If a team does not have an ordering provider, they may apply for the Communicable Disease Medical Health Officer and Team to assume the functions of ordering and follow-up
• Take the necessary training through LearningHub (approximately 1 hour)
• Purchase the general supplies required (e.g., gloves, alcohol swabs, sharps containers)
  • Sample collection supplies like lancets and specimen cards are provided by the NML

To learn more about DBST, please check DBST guide.