Introduction: Our Healthbox (www.ourhealthbox.ca) is a network of interactive dispensing systems hosted by community-based organizations, providing free, low-barrier, anonymous access to HIV self-testing kits, harm reduction supplies, sexual health and other wellness items along with health resources for people to find the care they need. The program launched in January 2023 has 5 Healthboxes in New Brunswick, 4 in Ontario, and 1 in Manitoba and 1 in Alberta.
Methods: We evaluated data for the first 4,000 participants who accessed items and described participant demographics, supplies dispensed and reason for accessing items using data collected from sign-up, dispensing and post-access survey questions between January 23, 2023 and November 30, 2024.
Results: The 11 Healthboxes currently in communities had 25,000+ uses by 4,000 unique participants who accessed 33,000+ items. Overall: 58% participants were male, 76% under 40 years, 46% identified as heterosexual, 62% educated (≥high school), 60% were under-housed, 64% had difficulty paying for basic needs, 67% saw a healthcare provider within the last year and 65% used opioids and stimulants. Supplies accessed: 18,500+ harm reduction items (35% were safe injecting supplies) including 984 naloxone kits/refills, 2,600+ sexual health supplies (including menstrual products) and 11,000+ wellness items. Overall, 503 participants accessed 841 HIVST kits (61% by New Brunswickers); 47% were first-time testers, 13% identified as gay, bisexual or men who have sex with men, 8% as African, Caribbean or Black, 36% as Indigenous, 33% were women and 87% used substances. People connected to care: 14 started pre-exposure prophylaxis, 5 started post-exposure prophylaxis and 2 started HIV treatment. Participants found Our Healthbox acceptable and over 60% felt it helped to reduce stigma around accessing HIV testing.
Conclusion: Our Healthbox program is reaching key populations where they live without judgment, when they need it. We aim to implement 100 machines in communities across Canada.

Background: Facility-based HIV testing in Canada is predominantly available in urban areas, with limited access in rural communities. These inequities are exacerbated by health disparities across key populations affected by HIV. The I’m Ready Program provides access to HIV self-testing across Canada via mail delivery or local pick-up from community agencies. This study evaluated the program’s effectiveness in reaching people in urban, rural and remote areas by race and key priority populations.

Methods: I’m Ready reached 11,219 people from June 2021 to October 2024. Rates of testing were examined by population size: in very large urban (>200,000 people), large urban (100,000-199,999), medium (30,000-99,999), small (1,000-29,999) and rural (<1,000) areas. Chi-squared tests (p<0.05) examined rates of first-time testers across race and key populations by the five location sizes.

Results: Most participants (75%) lived in urban areas (>100,000 people) with 25% living in smaller/rural areas. Overall, 34% of participants were first-time testers, varying significantly from 31% in very large urban to 45% in rural areas. High rates of first-time testers were seen across all location sizes for youth, and for cis-women in small/rural areas. There were higher rates of first-time testers for people who identified as Asian or Middle Eastern/North African in very large/large urban areas, but similar rates of all other races (Caucasian, Black and Indigenous) across rural, small, and medium-sized areas. In rural areas, Black and Indigenous populations had higher proportions of first-time testers, while there were lower rates of people who identified as gbMSM and people who use substances.

Conclusion: I’m Ready program was effective at reaching people from all key populations and racial groups across all population sizes. This demonstrates the potential and need for a technology solution to advance health equity across diverse population settings, particularly in underserved small and rural areas with limited testing options.

Background: In 2020, we established the first nurse-led asynchronous online STI/HIV testing platform, known as GetaKit.ca. The site offered clinically-indicated testing for STIs/HIV based on clinical guidelines. Services operated in collaboration with public health agencies, who acted as local ordering providers and facilitated linkage-to-care for persons with positive test results.

Results: Since launching GetaKit.ca in 2020 and adding full STI testing mid-2023, 17 public health units in Ontario (over half of those in the province) now use the platform to offer testing to their residents. This system thus has a population coverage of over 9 million Ontarians (or 9% of all Canadians). Results from the last 12 months (i.e., Jan-Dec 2024) showed high uptake of GetaKit.ca, with >10,000 requests made for STI testing, of whom >80% belonged to an equity denied group. We completed a sub-analysis of data from Ottawa, Canada, which allowed us to evaluate the outcomes of online testing versus all STI/HIV testing done in this city of over 1 million residents. We found that, for GetaKit.ca, 53% of participants were cis-male, 41% cis-female, and 6.3% trans/nonbinary. By ethnicity, 15% were Black, 2.5% Indigenous, and 58% white. 31% identified as men who have sex with men (MSM). For testing, we diagnosed 353 STIs/HIV, yielding positivity rates of 1.5% for gonorrhea, 3.8% for chlamydia, 1.8% for syphilis, 0.5% for hepatitis C, and 0.2% for HIV. Overall, GetaKit.ca accounted for 5% of all STI/HIV diagnoses in Ottawa in 2024, and 36% of all STI/HIV diagnosis by Ottawa Public Health in that year; notably, 10% of all STI/HIV diagnoses in 2024 among MSM in Ottawa occurred through this platform. Lastly, >28% of users noted this was their first-time undergoing STI/HIV testing.

Interpretation: We take these findings to signal that online asynchronous nurse-led STI/HIV testing platforms can yield beneficial clinical/public health outcomes.

Across Ontario, syphilis rates have increased by 300% in the last decade, prompting demands for advancements in diagnostics and testing accessibility. Currently no Health Canada approved syphilis point-of-care tests (POCTs) can distinguish between active and historical infections, meaning only laboratory methods are used, resulting in syphilis management delays and ongoing transmission. Consequently, we decided to evaluate a complete antibody (TP/nTP) syphilis POCTs in a clinical setting to compare its results to serology, which could allow public health workers to immediately diagnose and treat syphilis.
We are undertaking an 18-month (2024-2025) cross-sectional investigational study at the Sexual Health Clinic in Ottawa, involving 800 participants using the MedMira Multiplo ® device. As part of this study evaluation, we will compare the results of syphilis POCTs to serology, evaluating the sensitivity, specificity, and utility of the POCT.
To the end of 2024, 383 total individuals were approached to participate in the syphilis POCT study with 304 participants enrolled. Of 293 investigative results, we observed 219 non-reactive results (concordance rate of 95% [n=208]) and 74 reactive results (concordance rate of 75% [n=52]). Overall concordance between POCT and serology results was 89%. Among those with reactive syphilis serology results, almost three-quarters (n=53) of participants had results indicative of historical syphilis and one-quarter (n=16) were new infections. Of those with new syphilis infections, 11 participants had infectious syphilis, with 81% (n=9) being diagnosed/treated in clinic based on POCT results and presenting issue. To date, the study has yielded a syphilis positivity rate of 24% for all participants and 5% for participants with new infections.
Our current findings suggest that together with syphilis history and clinical assessment, syphilis POCT can be a useful tool to rule-out syphilis, confirm previous treatment, and guide management of infections – particularly when these devices can distinguish between active and historical infections.

INTRODUCTION: Middle Eastern and North African (MENA) diaspora gay/bisexual/MSM (GBM) and trans/gender diverse (TGD) youth bear disproportionate burden of STIs & HIV and experience unique mental health challenges. Mindfulness-based training has shown benefits for mental and physical health with other racialized groups. We assessed the feasibility and acceptability of a mindfulness pilot-intervention with MENA GBM and TGD youth in Ontario.

METHOD: We ran a mixed-methods pilot intervention: Self-Compassion, Mindful Acceptance & Resilience Transformation (SMART), an 8-week group-based mindfulness training. Participants (N=40) were randomized (1:1) to receive either SMART intervention immediately (intervention group), or 8 weeks after initial baseline (delayed waitlist control group). Youth attended group mindfulness intervention via video conference for 2 hrs/week for 8 weeks. Online surveys collected quantitative data in pre-and post-intervention, and 3 months post-intervention, with outcome variables/measures: Primary: Feasibility & acceptability. Secondary: Depression, Anxiety and Stress (DASS-21); Self-compassion (SCS-SF). Exploratory: Resilience (ARM-R); Mindfulness (CAMS-R). Focus groups collected qualitative data at 3 months post-intervention.

PRELIMINARY RESULTS: Focus group discussions demonstrated feasibility and acceptability of mindfulness training. P-values for all outcome variables show no statistically significant difference between treatment and control groups at baseline. Depression: η^2=0.0234, indicating a small effect size, with 2.34% of variance explained by group differences; Cohen’s d=-0.2906 suggests small negative effect size, with treatment group showing slightly greater reduction than control group. Mindfulness: η^2=0.0409, a small effect size, explaining 4.09% of variance; Cohen’s d=0.3926 indicates a small-to-medium effect size in favour of treatment group. Resilience, η^2=0.0651, reflecting a medium effect size, with 6.51% of variance explained by group differences; d= 0.5 reflects a medium effect size in favour of treatment group.

CONCLUSION: Results are important for planning a future randomized controlled trial, including estimating effect sizes for sample size calculations, identifying and addressing potential challenges to recruitment and implementation, and refining intervention for cultural relevance.

Background: Needle and syringe programs (NSP) are evidence-based interventions for preventing HIV and hepatitis C virus (HCV) transmission, but are vulnerable to funding cutbacks, especially amid declining incidence. We explored the potential impacts of reduced NSP access on HIV and HCV among people who inject drugs (PWID) in Montréal.

Methods: Using a dynamic model of HIV/HCV co-transmission parameterized and calibrated to surveillance data (2003-2018), we simulated funding reductions by reducing NSP reach (percent PWID accessing NSP), which was stable at 82%, except during the COVID-19 pandemic (reduced to 70%). We modelled scenarios over 2024-2030, where NSP reach declined from 82% (status quo) in 10%-decrements, from 80%-50%, and estimated the impacts on incidence of 1) HIV and 2) chronic HCV (overall and among PWID living with HIV).

Results: Baseline (2024) HIV and chronic HCV incidence per 100 person-years was 1 (95% credible interval [CrI]: 0-2) and 7 (95%CrI: 4-10), respectively. Reducing NSP reach, even to 70%, increased the incidence of both over 2024-2030 (Table). By 2030, the estimated HIV incidence was 7% (95%CrI: 1%-14%) to 19% (95%CrI: 2%-41%) higher than the status quo. Chronic HCV incidence was 5% (95%CrI: 1%-14%) to 15% (95%CrI: 3%-43%) higher among all PWID in 2030, with similar changes among PWID living with HIV.

Conclusions: Our preliminary results suggest that sustaining NSP availability in Montréal remains important to prevent HIV and HCV acquisition, despite low baseline incidence. As entry points for testing, treatment, or opioid agonist therapies, reduced NSP services could further undermine broader harm reduction efforts.

Background: 2024 marked the 10 year anniversary of the launch of GetCheckedOnline, BC’s digital sexually transmitted and blood-borne infection (STBBI) testing program, now available in 9 communities with > 30,000 test visits per year. Services like GetCheckedonline are complex health system interventions, with many parts interacting across multiple health organizations, systems and contexts, and may be challenging to sustain over the long term. We aimed to understand the perspectives of implementers what lessons could be learned about sustainability from GetCheckedOnline that may be relevant in other contexts.

Methods: We conducted interviews and focus groups with 45 staff from multiple regional and provincial organizations involved in implementing GetCheckedOnline from initial planning (2009) to current scale-up (2024). Organizations spanned clinical, public health, laboratory, government and community sectors. Factors perceived as contributing to sustainability of the service were identified from observer notes using framework analysis based on the Consolidated Framework for Sustainability Constructs in Health Care.

Results: The most commonly identified factors perceived as contributing to the sustainability of GetCheckedOnline were related to the framework’s constructs of People Involved, Resources, and Negotiating Initiative Processes. Building GetCheckedOnline required interdisciplinary teams, collaborations, and new partnerships across health system program silos and organizations, as well as identifying the required teams and functions needed for implementation. Building and maintaining relationships by program staff—which took time and resources—was recognized as critical and cut across multiple framework constructs.

Conclusion: Based on our study, multiple factors contributed to sustaining GetCheckedOnline, speaking to its complexity and need for for interdisciplinary teams, new partnerships within and across organizations and systems, integrated operations, and a foundation of strong relationships. Incorporating and appropriately resourcing processes that that reflect these factors during the planning, implementation and scale-up of digital testing or other digital sexual health services may maximize their sustainability.

Background:
Human Immunodeficiency Virus (HIV) and Hepatitis C Virus (HCV) disproportionately affect incarcerated populations. Point-of-care (POC) testing in correctional facilities addresses barriers associated with traditional testing. Pharmacists can play a key role in delivering POC testing and addressing these gaps. We aimed to determine the feasibility of pharmacist-led POC testing for HIV and HCV in rural correctional facilities in Newfoundland and Labrador.

Methods:
This prospective, interventional pilot study invited incarcerated individuals at three rural NL correctional facilities to participate. Testing occurred in January and February 2024. Pharmacists provided education, conducted voluntary HIV and HCV POC testing, explained results, and arranged confirmatory testing if needed. Participants completed pre-test surveys to capture demographics and risk behaviors. Pharmacist work logs were used to document the total number of tests conducted to measure testing uptake, the outcomes of POC testing (reactive or nonreactive), and the confirmation of new diagnoses through confirmatory test results. Testing, demographic, and risk behavior data were analyzed using descriptive statistics.

Results:
Of 103 incarcerated individuals, 75 volunteered for testing. Pharmacists performed 58 HCV and 73 HIV tests on 74 participants. No reactive HIV results were identified, however six HCV tests were reactive. All six participants, along with an additional four who were within the window period for exposure, underwent confirmatory testing. Four new HCV cases were diagnosed, all of which received follow-up care. The majority of participants had either no history or no known history of prior HIV testing (68%) or HCV testing (58%). A total of 79% of participants disclosed a history of substance use, while 82% reported having more than one sexual partner in the past year.

Conclusion:
Pharmacist-led POC testing for HIV and HCV in rural correctional facilities is highly feasible. Expanding such services could improve diagnoses and reduce the burden of these infections among incarcerated populations.