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O'Byrne P, MacPherson P, Orser L. Approche du dépistage des infections transmissibles sexuellement chez les hommes ayant des rapports sexuels avec des hommes. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:e89-e96. [PMID: 39122438 PMCID: PMC11328719 DOI: 10.46747/cfp.700708e89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Affiliation(s)
- Patrick O'Byrne
- Infirmier praticien et professeur à l'École des sciences infirmières de la Faculté des sciences de la santé de l'Université d'Ottawa (Ontario)
| | - Paul MacPherson
- Infectiologue à Ottawa, professeur agrégé et directeur de la recherche clinique en santé des hommes gais au Département de médecine de l'Université d'Ottawa
| | - Lauren Orser
- Infirmière autorisée et candidate au doctorat à l'École des sciences infirmières de l'Université d'Ottawa
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O'Byrne P, MacPherson P, Orser L. Approach to sexually transmitted infection testing for men who have sex with men. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2024; 70:449-455. [PMID: 39122439 PMCID: PMC11328724 DOI: 10.46747/cfp.700708449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To provide a guide on appropriate sexually transmitted infection (STI) testing for primary care providers to use with patients who identify as men who have sex with men (MSM). SOURCES OF INFORMATION Canadian guidelines for STI testing and enteric and protozoan infections; Ontario guidelines for HIV screening and mpox; and US guidelines for STI testing. MAIN MESSAGE Across Canada rates of sexually transmitted bacterial, enteric, protozoan, and systemic infections-including HIV and mpox-have been steadily increasing among cisgender and transgender MSM. Despite often having similar clinical presentations, these infections have different incubation periods and testing approaches and must be ruled out effectively to guide diagnosis and treatment for MSM-identifying patients who present with symptoms of various conditions. Clinical information and screening recommendations, however, are often found in multiple guidelines rather than in a single source, thus further complicating these clinical encounters. This document provides a consolidated set of evidence and recommendations for STI testing in MSM. CONCLUSION Testing approaches for STIs should be comprehensive and based on the patient's reported risk factors and clinical presentation. Where ongoing STI risk is identified and negative laboratory test results are received, MSM should also be counselled on recommendations for repeat screening and HIV prevention services, such as preexposure prophylaxis.
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Affiliation(s)
- Patrick O'Byrne
- Nurse practitioner and Professor in the School of Nursing in the Faculty of Health Sciences at the University of Ottawa in Ontario
| | - Paul MacPherson
- Infectious diseases specialist physician in Ottawa and Associate Professor and Clinical Research Chair in Gay Men's Health in the Department of Medicine at the University of Ottawa
| | - Lauren Orser
- Registered nurse and a doctoral candidate in the School of Nursing at the University of Ottawa
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Tran A, Tran N, Tapa J, Tieosapjaroen W, Fairley CK, Chow EPF, Zhang L, Baggaley RC, Johnson CC, Jamil MS, Ong JJ. A typology of HIV self-testing support systems: a scoping review. Sex Health 2024; 21:SH24037. [PMID: 38950142 DOI: 10.1071/sh24037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/04/2024] [Indexed: 07/03/2024]
Abstract
To maximise the benefits of HIV self-testing (HIVST), it is critical to support self-testers in the testing process and ensure that they access appropriate prevention and care. To summarise systems and tools supporting HIVST (hereafter, 'support systems') and categorise them for future analysis, we synthesised the global data on HIVST support systems and proposed a typology. We searched five databases for articles reporting on one or more HIVST support systems and included 314 publications from 224 studies. Across 189 studies, there were 539 reports of systems supporting HIVST use; while across 115 studies, there were 171 reports of systems supporting result interpretation. Most commonly, these were pictorial instructions, followed by in-person demonstrations and in-person assistance while self-testing or reading self-test results. Less commonly, virtual interventions were also identified, including online video conferencing and smartphone apps. Smartphone-based automated result readers have been used in the USA, China, and South Africa. Across 173 studies, there were 987 reports of systems supporting post-test linkage to care; most commonly, these were in-person referrals/counselling, written referrals, and phone helplines. In the USA, Bluetooth beacons have been trialled to monitor self-test use and facilitate follow-up. We found that, globally, HIVST support systems use a range of methods, including static media, virtual tools, and in-person engagement. In-person and printed approaches were more common than virtual tools. Other considerations, such as linguistic and cultural appropriateness, may also be important in the development of effective HIVST programs.
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Affiliation(s)
- Arron Tran
- Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia; and Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia
| | - Nghiep Tran
- Melbourne Medical School, Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne, Melbourne, Vic, Australia
| | - James Tapa
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia
| | - Warittha Tieosapjaroen
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Christopher K Fairley
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Eric P F Chow
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; and Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia
| | - Lei Zhang
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia
| | - Rachel C Baggaley
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Cheryl C Johnson
- Global HIV, Hepatitis and STI Programmes, World Health Organization, Geneva, Switzerland
| | - Muhammad S Jamil
- Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Jason J Ong
- Melbourne Sexual Health Centre, Alfred Health, Melbourne, Vic, Australia; and Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic, Australia; and Department of Communicable Diseases, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
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Shi F, Zhang J, Chen S, Yang X, Li Z, Weissman S, Olatosi B, Li X. Multi-level Factors Associated with HIV Late Presentation with Advanced Disease and Delay Time of Diagnosis in South Carolina, 2005-2019. AIDS Behav 2024:10.1007/s10461-024-04414-y. [PMID: 38896338 DOI: 10.1007/s10461-024-04414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
This study explored individual- and county-level risk factors of late presentation with advanced disease (LPAD) among people with HIV (PWH) and their longer delay time from infection to diagnosis in South Carolina (SC), using SC statewide Enhanced HIV/AIDS Reporting System (eHARS). LPAD was defined as having an AIDS diagnosis within three months of initial HIV diagnosis, and delay time from HIV infection to diagnosis was estimated using CD4 depletion model. 3,733 (41.88%) out of 8,913 adult PWH diagnosed from 2005 to 2019 in SC were LPAD, and the median delay time was 13.04 years. Based on the generalized estimating equations models, PWH who were male (adjusted prevalence ratio [aPR]: 1.22, 95% CI: 1.12 ∼ 1.33), aged 55+ (aPR: 1.76, 95% CI: 1.62 ∼ 1.92), were Black (aPR: 1.09, 95% CI: 1.03 ∼ 1.15) or Hispanic (aPR: 1.42, 95% CI: 1.26 ∼ 1.61), and living in counties with a larger proportion of unemployment individuals (aPR: 1.02, 95% CI: 1.01 ∼ 1.03) were more likely to be LPAD. Among PWH who were LPAD, Hispanic (adjusted beta: 1.17, 95% CI: 0.49 ∼ 1.85) instead of Black (adjusted beta: 0.11, 95% CI: -0.30 ∼ 0.52) individuals had significant longer delay time compared to White individuals. Targeted and sustained interventions are needed for older, male, Hispanic or Black individuals and those living in counties with a higher percentage of unemployment because of their higher risk of LPAD. Additionally, specific attention should be paid to Hispanic individuals due to their longer delay time to diagnosis.
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Affiliation(s)
- Fanghui Shi
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA.
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
| | - Jiajia Zhang
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Shujie Chen
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xueying Yang
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Zhenlong Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Geography, College of Earth and Mineral Sciences, The Pennsylvania State University, University Park, PA, 16802, USA
| | - Sharon Weissman
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia, SC, 29208, USA
| | - Bankole Olatosi
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA
| | - Xiaoming Li
- Arnold School of Public Health, South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, SC, 29208, USA
- SC SmartState Center for Healthcare Quality (CHQ), Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
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O'Byrne P, Kroch A, Orser L, Ho N, Musten A, Haines M, Lindsay J. Targeted HIV Self-Testing Identifies Persons with Undiagnosed HIV and Active Engagement Links them to Care: The GetaKit Study. AIDS Behav 2024; 28:2015-2022. [PMID: 38526637 PMCID: PMC11161533 DOI: 10.1007/s10461-024-04302-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/27/2024]
Abstract
Current international HIV testing guidelines recommend that HIV negative persons from HIV priority groups complete repeat screening every 3-6 months; local guidelines in our jurisdiction recommend that such retesting should occur every 3 months. Such an approach allows for timely HIV diagnosis and linkage to care - and aligns with the UNAIDS 95-95-95 targets to have 95% of undiagnosed persons be aware of their HIV status. To meet these aims, new approaches to HIV testing have been developed, including our HIV self-testing initiative, GetaKit.ca, which uses an online screening algorithm to determine eligibility and has built in pathways for re-test reminders, linkage HIV prevention care, and rapid follow-up for positive test results. To understand self-testing frequency in relation to our local recommendations for resting every 3 months, we evaluated data from participants who ordered repeat HIV self-tests through GetaKit.ca. Descriptive analyses were performed on participant characteristics and chi-square tests were performed on aggregated participant risk data. During the study period, 5235 HIV self-tests were distributed to 3627 participants, of whom, 26% ordered more than once and 27% belonged to an HIV priority population. Participants who retested were more likely to have been white, male, and part of an HIV priority population; they were also more likely to have completed prior STI or HIV testing or had a prior STI diagnosis, compared to those who did not. We identified 16 new HIV diagnoses, 2 of which were among repeat testers. Our results suggest that HIV self-testing can be useful to help meet UNAIDS targets to identify undiagnosed infections; however, such efforts are less likely to be successful without adequate linkage to follow-up services, including HIV treatment and prevention care.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, ON, Canada.
| | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Nikki Ho
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | | | - Marlene Haines
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
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Orser L, Squires JE, Musten A, Ho N, Lindsay J, Pai NP, O'Byrne P. Real world outcomes of distributing Lucira Check-It® COVID self-tests in Ontario, Canada: the GetaKit COVID study. BMC Public Health 2024; 24:485. [PMID: 38360568 PMCID: PMC10870641 DOI: 10.1186/s12889-024-17783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND In Ontario, Canada we developed and implemented an online screening algorithm for the distribution of HIV self-tests, known as GetaKit. During the COVID pandemic, we adapted the GetaKit algorithm to screen for COVID based on population and infection data and distributed COVID rt-LAMP self-tests (using the Lucira Check-It®) to eligible participants. METHODS GetaKit/COVID was a prospective observational study that occurred over a 7-month period from September 2021 to April 2022. All potential participants completed an online registration and risk assessment, including demographic information, COVID symptoms and risk factors, and vaccination status. Bivariate comparisons were performed for three outcomes: results reporting status, vaccination status, and COVID diagnosis status. Data were analysed using Chi-Square for categorial covariates and Independent Samples T-Test and Mann-Whitney U test for continuous covariates. Bivariate logistic regression models were applied to examine associations between the covariates and outcomes. RESULTS During the study period, we distributed 6469 COVID self-tests to 4160 eligible participants; 46% identified as Black, Indigenous or a Person of Colour (BIPOC). Nearly 70% of participants reported their COVID self-test results; 304 of which were positive. Overall, 91% also reported being vaccinated against COVID. Statistical analysis found living with five or fewer people, having tested for COVID previously, and being fully vaccinated were positive factors in results reporting. For COVID vaccination, people from large urban centers, who identified their ethnicity as white, and who reported previous COVID testing were more likely to be fully vaccinated. Finally, being identified as a contact of someone who had tested positive for COVID and the presence of COVID-related symptoms were found to be positive factors in diagnosis. CONCLUSIONS While most participants who accessed this service were vaccinated against COVID and the majority of diagnoses were identified in participants who had symptoms of, or an exposure to, COVID, our program was able to appropriately link participants to recommended follow-up based on reported risks and results. These findings highlight the utility of online screening algorithms to provide health services, particularly for persons with historical barriers to healthcare access, such as BIPOC or lower-income groups.
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Affiliation(s)
- Lauren Orser
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Janet E Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Alexandra Musten
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Nikki Ho
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Jennifer Lindsay
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Nitika Pant Pai
- Department of Medicine, School of Population and Global Health, McGill University, 5252 Boulevard de Maisonneuve W., Montréal, QC, H4A 3S5, Canada
| | - Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada.
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Chen S, Fang Y, Chan PSF, Kawuki J, Mo P, Wang Z. Counseling Supporting HIV Self-Testing and Linkage to Care Among Men Who Have Sex With Men: Systematic Review and Meta-Analysis. JMIR Public Health Surveill 2024; 10:e45647. [PMID: 38265866 PMCID: PMC10851126 DOI: 10.2196/45647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 10/06/2023] [Accepted: 12/14/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Counseling supporting HIV self-testing (HIVST) is helpful in facilitating linkage to care and promoting behavior changes among men who have sex with men (MSM). Different levels of counseling support for MSM HIVST users may lead to variance in the linkage to care. OBJECTIVE This study aims to synthesize evidence on counseling supporting MSM HIVST users and to conduct a meta-analysis to quantify the proportion of MSM HIVST users who were linked to care. METHODS A systematic search was conducted using predefined eligibility criteria and relevant keywords to retrieve studies from the MEDLINE, Global Health, Web of Science, Embase, APA PsycINFO, and Scopus databases. This search encompassed papers and preprints published between July 3, 2012, and June 30, 2022. Studies were eligible if they reported counseling supporting HIVST or quantitative outcomes for linkage to care among MSM and were published in English. The screening process and data extraction followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The quality of the included studies was assessed by the National Institutes of Health quality assessment tool. Data were extracted using random effects models to combine the proportion of HIVST users who were linked to care. Subgroup analyses and metaregression were conducted to assess whether linkage to care varied according to study characteristics. All analyses were performed with R (version 4.2.1; R Foundation for Statistical Computing) using the metafor package. RESULTS A total of 55 studies published between 2014 and 2021, including 43 observational studies and 12 randomized controlled trials, were identified. Among these studies, 50 (91%) provided active counseling support and 5 (9%) provided passive counseling support. In studies providing active counseling support, most MSM HIVST users were linked to various forms of care, including reporting test results (97.2%, 95% CI 74.3%-99.8%), laboratory confirmation (92.6%, 95% CI 86.1%-96.2%), antiretroviral therapy initiation (90.8%, 95% CI 86.7%-93.7%), and referral to physicians (96.3%, 95% CI 85%-99.2%). In studies providing passive counseling support, fewer MSM HIVST users were linked to laboratory confirmation (78.7%, 95% CI 17.8%-98.4%), antiretroviral therapy initiation (79.1%, 95% CI 48.8%-93.7%), and referral to physicians (79.1%, 95% CI 0%-100%). Multivariate metaregression indicated that a higher number of essential counseling components, a smaller sample size (<300), and the use of mobile health technology to deliver counseling support were associated with better linkage to care. The quality of the studies varied from fair to good with a low to high risk of bias. CONCLUSIONS Proactively providing counseling support for all users, involving a higher number of essential components in the counseling support, and using mobile health technology could increase the linkage to care among MSM HIVST users. TRIAL REGISTRATION PROSPERO CRD42022346247; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=346247.
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Affiliation(s)
- Siyu Chen
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Yuan Fang
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Paul Shing-Fong Chan
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Joseph Kawuki
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Phoenix Mo
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
| | - Zixin Wang
- Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China (Hong Kong)
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Wang J, Wang G, Zhu X, Li L, Kang D, Liu Y, Zhang N. The care status and factors affecting antiretroviral therapy timing for people living with HIV: a retrospective cohort study in Shandong Province, China. AIDS Care 2023; 35:1963-1970. [PMID: 36919489 DOI: 10.1080/09540121.2023.2185197] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 02/21/2023] [Indexed: 03/16/2023]
Abstract
This study described the care status of People Living with HIV (PLWH) including antiretroviral therapy (ART) and viral suppression from 2018 to 2020. We recognized that immediate ART was associated with improved viral suppression. Therefore, we also aimed to explore the factors affecting the early initiation of ART. We initiated a retrospective cohort study to evaluate the care status of people living with HIV in Shandong Province. From 2018 to 2020, patients infected by homosexual transmission in particular had a higher ART rate (78.82%, 79.69%, and 87.72%, respectively). Of PLWH who received ART, 79.57%, 77.63%, and 67.71% achieved viral suppression, respectively. However, COVID-19 may affect the rate of ART and viral suppression, which we need to explore in our research. From 2018 to 2020, the proportion of immediate antiretroviral therapy within 30 days of diagnosis increased from 48.12% to 65.42%. Multivariate logistic regression demonstrated that patients with junior college degree or above (OR, 1.39 [95%CI, 1.12-1.73]) and key population or medical institutions (OR, 3.62 [95%CI, 2.18-6.16]; OR, 3.88 [95%CI, 2.33-6.59]) were substantially likely to receive ART immediately, while patients outside the province (OR, 0.60 [95%CI, 0.50-0.73]) were less likely to receive ART immediately.
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Affiliation(s)
- Jiongjiong Wang
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Guoyong Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Xiaoyan Zhu
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Ling Li
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Dianmin Kang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
| | - Yunxia Liu
- Department of Biostatistics, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, People's Republic of China
| | - Na Zhang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, People's Republic of China
- Institute of Preventive Medicine, Shandong University, Jinan, People's Republic of China
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O'Byrne P, Musten A. HIV self-testing: what GetaKit can tell us about Canada's $8 million one-time investment. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:867-871. [PMID: 37052747 PMCID: PMC10484860 DOI: 10.17269/s41997-023-00768-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023]
Abstract
At the 16th International AIDS Conference in Montreal, Canada's Federal Health Minister announced that the Government of Canada will invest $17 million to increase access to HIV testing, $8 million of which would be used to purchase and distribute HIV self-tests. While HIV testing, and subsequent diagnoses, is a critical first step to achieving the updated UNAIDS goals of 95-95-95, testing on its own does not guarantee linkage to treatment or prevention services. In other words, it does not alone guarantee progress toward the 95-95-95 goals. GetaKit, Canada's first HIV self-test mail-out project, has demonstrated that a preliminary risk-assessment consistent with US CDC and PHAC screening guidelines ensures targeted uptake among communities most affected by HIV, thus minimizing the risk of false positive results and poor positive predictive values. Furthermore, HIV self-testing must link not only individuals with positive results to treatment, but also persons with negative results to pre-exposure prophylaxis (PrEP) along with re-testing as required. However, both access to treatment and PrEP remain inconsistently available across Canada. Therefore, while this one-time investment of funding to increase HIV testing is encouraging, without clear instructions as to who should be prioritized for testing and definitive next steps to ensure that individuals are successfully linked to care, Canada risks wasting resources, further exacerbating pre-existing inequities.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada.
| | - Alexandra Musten
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada
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Iyamu I, Pedersen H, Ablona A, Chang HJ, Worthington C, Grace D, Grennan T, Wong J, Salmon A, Koehoorn M, Gilbert M. Evaluating the Impact of the COVID-19-Related Public Health Restrictions on Access to Digital Sexually Transmitted and Blood-Borne Infection Testing in British Columbia, Canada: An Interrupted Time Series Analysis. Sex Transm Dis 2023; 50:595-602. [PMID: 37195276 PMCID: PMC10430673 DOI: 10.1097/olq.0000000000001833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/03/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Evidence of long-term impacts of COVID-19-related public health restrictions on digital sexually transmitted and blood-borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). METHODS Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, and testers' sociodemographic and sexual risk profiles, for the prepandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analyzed. Each outcome was modeled using segmented generalized least squared regression. RESULTS Overall, 17,215 and 22,646 test episodes were conducted in the prepandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021 (end of the pandemic period), monthly GetCheckedOnline testing increased by 21.24 test episodes per million BC residents (95% confidence interval, -11.88 to 54.84), and GetCheckedOnline tests per 100 tests in corresponding BC regions increased by 1.10 (95% confidence interval, 0.02 to 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, whereas monthly GetCheckedOnline testing increased among people 40 years or older, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. CONCLUSIONS Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.
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Affiliation(s)
- Ihoghosa Iyamu
- From the School of Population and Public Health, University of British Columbia
- BC Centre for Disease Control (BCCDC), Vancouver
| | | | - Aidan Ablona
- BC Centre for Disease Control (BCCDC), Vancouver
| | | | - Catherine Worthington
- School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia
| | - Daniel Grace
- Dalla Lana School of Public Health, University of Toronto, Ontario
| | - Troy Grennan
- BC Centre for Disease Control (BCCDC), Vancouver
- Centre for Health Evaluation and Outcomes Sciences (CHÉOS), Vancouver, Canada
| | - Jason Wong
- BC Centre for Disease Control (BCCDC), Vancouver
| | - Amy Salmon
- From the School of Population and Public Health, University of British Columbia
- Centre for Health Evaluation and Outcomes Sciences (CHÉOS), Vancouver, Canada
| | - Mieke Koehoorn
- From the School of Population and Public Health, University of British Columbia
- Centre for Health Evaluation and Outcomes Sciences (CHÉOS), Vancouver, Canada
| | - Mark Gilbert
- From the School of Population and Public Health, University of British Columbia
- BC Centre for Disease Control (BCCDC), Vancouver
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11
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Orser L, O'Byrne P, Holmes D. Patient perspectives on the role of nurses in HIV pre-exposure prophylaxis care (PrEP-RN). PLoS One 2023; 18:e0288283. [PMID: 37467214 DOI: 10.1371/journal.pone.0288283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 06/23/2023] [Indexed: 07/21/2023] Open
Abstract
INTRODUCTION In response to ongoing new HIV diagnoses among gay, bisexual, and other men who have sex with men (gbMSM) and limited access points for HIV pre-exposure prophylaxis (PrEP) care, we established Canada's first nurse-led HIV prevention service in Ottawa, Canada-PrEP-RN. As part of this service, registered nurses became the primary provider in PrEP delivery and monitoring. OBJECTIVES To (1) gather patients' sentiments and experiences related to nurse-led PrEP and (2) identify the implications for nurses working in sexual healthcare. METHODOLOGY Qualitative interviews were conducted with 14 gbMSM participants who had received, or were presently enrolled in, HIV prevention care from nurses in the PrEP-RN clinic. Interview transcripts were reviewed and analyzed using thematic analysis. RESULTS Our analysis revealed two major themes of: The Sexual Health Nurse as the Expert and Patients Reliance on Nurses. The first theme discussed patients' positive attitudes toward nurses, in terms of the knowledge nurses possessed and the kind and efficient services they. The accommodating nature of nurses, however, led patients to become dependent on their care, which was the focus of the second theme. This reliance on nurses created challenges when patients transitioned from PrEP-RN to alternate providers for ongoing care. CONCLUSION These findings were examined to understand the effect of patients' perceptions of nurses on nursing practice. Despite patients' confidence in nurses' ability to provide PrEP care, the expectations they placed onto nurses to address the totality of their needs created competing demands for nurses to be both a leader in HIV prevention care-and fulfill the image of the caring, healthcare 'hero', which created feelings of moral distress among nurses. As increasing initiatives focus on task-shifting of healthcare roles to nurses, understanding the patients' perspective is essential in maintaining effective nurse-patient relationships.
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Affiliation(s)
- Lauren Orser
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Patrick O'Byrne
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Dave Holmes
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
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12
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O'Byrne P, Orser L, Kroch A. Rates of sexually transmitted infections are rising. BMJ 2023; 381:1492. [PMID: 37391210 DOI: 10.1136/bmj.p1492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
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13
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Rosas Cancio-Suárez M, Alonso C, Vivancos MJ, Pérez-Elías MJ, Cárdenas MJ, Vélez-Díaz-Pallarés M, Corbacho MD, Martín-Pedraza L, Muriel A, Martínez-Sanz J, Moreno S. Impact of COVID-19 on the Care of Patients with HIV Infection. J Clin Med 2023; 12:3882. [PMID: 37373579 DOI: 10.3390/jcm12123882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic and associated lockdown measures have been associated with substantial disruptions to health care services, including screening for human immunodeficiency virus (HIV) and management of people living with HIV (PLWH). Data from 3265 patients were examined in a retrospective cohort study. We compared outpatient follow-up for PLWH, the number of new patients, treatment adherence, hospitalizations, and deaths during the "pandemic period" (March 2020 to February 2021), the "pre-pandemic period" (the equivalent time frame in 2019), and the "post-pandemic period" (March to September 2021). During the pandemic period, the number of new patients seen at the HIV clinic (116) as well as the requested viral load tests (2414) decreased significantly compared to the pre-pandemic (204 and 2831, respectively) and post-pandemic periods (146 and 2640, respectively) (p < 0.01 for all the comparisons). However, across the three study periods, the number of drug refills (1385, 1330, and 1411, respectively), the number of patients with undetectable viral loads (85%, 90%, and 93%, respectively), and the number of hospital admissions among PLWH remained constant. Despite the COVID-19 pandemic's impact, our findings show stability in the retention of clinical care, adherence to treatment, and viral suppression of PLWH, with no significant impact on hospitalization rates or all-cause mortality.
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Affiliation(s)
- Marta Rosas Cancio-Suárez
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - Cecilia Alonso
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | - María Jesús Vivancos
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - María Jesús Pérez-Elías
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - María José Cárdenas
- Microbiology Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | - Manuel Vélez-Díaz-Pallarés
- Pharmacy Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | - María Dolores Corbacho
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
| | - Laura Martín-Pedraza
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - Alfonso Muriel
- Biostatistics Department, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, 28034 Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Guadalajara Campus, 28801 Alcalá de Henares, Spain
| | - Javier Martínez-Sanz
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
| | - Santiago Moreno
- Department of Infectious Diseases, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, Carretera de Colmenar Km 9.1, 28034 Madrid, Spain
- CIBERINFEC, 28029 Madrid, Spain
- Department of Medicine, University of Alcalá de Henares, Guadalajara Campus, 28801 Alcalá de Henares, Spain
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O'Byrne P, McCready L, Tigert J, Musten A, Orser L. First-time testers in the GetaKit study: conceptualizing new paths to care for gbMSM. Health Promot Int 2023; 38:7143325. [PMID: 37099678 PMCID: PMC10132581 DOI: 10.1093/heapro/daad029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
When analyzing the data for Ontario, Canada, HIV rates continue to be highest among gay, bisexual and other men who have sex with men (gbMSM). Since HIV diagnosis is a key component of HIV care, self-testing has provided options for allowing this population to access care, resulting in a significant number of first-time testers. Between 1 April 2021 and 31 January 2022, 882 gbMSM participants ordered an HIV self-test through GetaKit. Of these, 270 participants reported that they had never undergone HIV testing previously. Our data showed that first-time testers were generally younger, members of BIPOC (Black, Indigenous and people of color) communities and they reported more invalid test results than those who had tested previously. This suggests that HIV self-testing may be a more successful and appealing component of the HIV prevention armamentarium for this population, but one that is not without its shortcomings as an entry to care.
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Affiliation(s)
| | - Lance McCready
- Leadership, Higher & Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | - Jason Tigert
- Leadership, Higher & Adult Education, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON, Canada
| | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ottawa, ON, Canada
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O'Byrne P, Musten A, McCready L, Robinson R, Durrant G, Tigert J, Orser L. HIV self-testing enabled access to testing for Black persons: The GetaKit study. Res Nurs Health 2023; 46:236-241. [PMID: 36573589 DOI: 10.1002/nur.22293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 12/05/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
In Ontario, new HIV diagnoses continue to affect gay, bisexual, and other men who have sex with men (gbMSM) and persons of African, Caribbean, or Black (ACB) ethnicities. Because treatment and suppressed viral loads flow from diagnosis, testing is key. We sought to determine the outcomes of online ordering and mail-out of free at-home HIV self-testing in Ontario, Canada. We implemented the GetaKit study to offer such free HIV self-testing using the INSTI® test and offered it via a website (GetaKit.ca) to eligible persons in Ontario. From April 1, 2021 to January 31, 2022, we distributed kits to 1551 persons; 40% were white and 26% were ACB. We found that ACB participants were less likely to fulfill established criteria for HIV PrEP, such as previous sexually transmitted infections diagnoses and drug use, despite having a similar test positivity rate. We also found that ACB women, who may represent a larger number of new infections than previously thought, did not have a higher rate of first-time testing. Our results suggest that HIV self-testing can enable testing, but that work is required to increase uptake among ACB persons and women. Overall, HIV self-testing thus corresponded with increased testing among persons who were Black, yet lower rates of results reporting. Patient or Public Contributions: Community members from the AIDS Committee of Ottawa, Max Ottawa, and Black Cap, and nurses from Ottawa Public Health were involved in the design, promotion, and implementation of this study.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | - Alexandra Musten
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
| | | | - Robin Robinson
- Black Coalition for AIDS Prevention, Ontario, Toronto, Canada
| | | | | | - Lauren Orser
- School of Nursing, University of Ottawa, Ontario, Ottawa, Canada
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16
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Ryu H, Blaque E, Stewart M, Anand P, Gómez-Ramírez O, MacKinnon KR, Worthington C, Gilbert M, Grace D. Disruptions of sexually transmitted and blood borne infections testing services during the COVID-19 pandemic: accounts of service providers in Ontario, Canada. BMC Health Serv Res 2023; 23:29. [PMID: 36635701 PMCID: PMC9836920 DOI: 10.1186/s12913-023-09028-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Since the onset of the COVID-19 pandemic in March 2020 in Canada, the availability of sexual health services including sexually transmitted and blood-borne infection (STBBI) testing has been negatively impacted in the province of Ontario due to their designation as "non-essential" health services. As a result, many individuals wanting to access sexual healthcare continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of testing, such as virtual interventions and self-sampling/testing. Our objective was to investigate service providers' experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario, Canada, and their acceptability of alternative testing services. METHODS Between October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n = 18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by three Peer Researchers and a Community Advisory Board was consulted throughout the research process. Transcripts were transcribed verbatim and analysed with NVivo software following grounded theory. RESULTS Service providers identified the reallocation of public health resources and staff toward COVID-19 management, and closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in access to sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing risks of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less onerous compared to traditional clinic-based models, and that they helped fill the gaps in testing caused by the pandemic. CONCLUSIONS Acceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario. There is a need to approach sexual health services as an essential part of healthcare and to sustain sexual health services that meet the needs of diverse individuals.
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Affiliation(s)
- Heeho Ryu
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON M5T 3M7 Canada
| | - Ezra Blaque
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON M5T 3M7 Canada
| | - Mackenzie Stewart
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON M5T 3M7 Canada
| | - Praney Anand
- Alliance for South Asian AIDS Prevention, Toronto, ON Canada
| | - Oralia Gómez-Ramírez
- grid.418246.d0000 0001 0352 641XBC Centre for Disease Control, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, BC Canada ,Canadian HIV Trials Network, Vancouver, BC Canada
| | - Kinnon R. MacKinnon
- grid.21100.320000 0004 1936 9430School of Social Work, York University, Toronto, ON Canada
| | - Catherine Worthington
- grid.143640.40000 0004 1936 9465School of Public Health and Social Policy, University of Victoria, Victoria, BC Canada
| | - Mark Gilbert
- grid.418246.d0000 0001 0352 641XBC Centre for Disease Control, Vancouver, BC Canada ,grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, BC Canada
| | - Daniel Grace
- grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, 155 College Street, 5th Floor, Room 556, Toronto, ON M5T 3M7 Canada
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17
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O'Byrne P, Orser L, Musten A, Ho N, Haines M, Lindsay J. Delivering COVID self-tests through GetaKit.ca: Creating testing access during a pandemic. Public Health Nurs 2023; 40:404-409. [PMID: 36625331 DOI: 10.1111/phn.13168] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To determine the real-world outcomes associated with using the GetaKit.ca website to distribute COVID self-tests to persons with risk factors, with a focus on facilitating testing for persons who are Black, Indigenous, or of Colour (BIPOC). METHODS GetaKit was an open cohort observational study to distribute free self-tests, starting with HIV self-testings and then adding the Lucira Check-It® COVID self-test. Participants would register on our website and complete a risk assessment, which would calculate their need for each type of testing. RESULTS Focusing on the COVID self-tests, from September to December 2021 (with targeted outreach in winter 2022), we distributed 6474 COVID self-tests to 3653 persons through 4161 unique orders, of which 47% came from BIPOC participants. Compared to white participants, BIPOC participants were more likely to have been a contact of COVID but less likely to be vaccinated. As well, 69% of results were reported back via the GetaKit.ca website, with 5.3% of these being positive. The positivity rate for our 3653 participants was 9.6%. CONCLUSIONS Delivering COVID self-tests via our website provided tests to BIPOC communities and yielded positivity rates that matched local COVID testing centres. This highlights the utility of such systems for delivering testing during future pandemics.
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Affiliation(s)
- Patrick O'Byrne
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Lauren Orser
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Alexandra Musten
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Nikki Ho
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Marlene Haines
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
| | - Jennifer Lindsay
- Faculty of Health Sciences, School of Nursing, Ottawa, Ontario, Canada
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Characterizing the Impact of the COVID-19 Pandemic on HIV PrEP care: A Review and Synthesis of the Literature. AIDS Behav 2022; 27:2089-2102. [DOI: 10.1007/s10461-022-03941-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2022] [Indexed: 12/03/2022]
Abstract
AbstractThe global COVID-19 pandemic and associated lockdown measures have caused disruptions to sexual health services and created additional barriers to the continuity of HIV pre-exposure prophylaxis (PrEP) among key populations. This review provides an examination of the influences of the pandemic on engagement in the PrEP care continuum. Using the PRISMA guideline, 46 studies were included in this review and the synthesis. Most of the studies were conducted in high-income settings through quantitative analysis. A majority of studies examining the changes in PrEP use suggested a decline or discontinuation in PrEP uptake during the pandemic. The most common reasons for stopping using PrEP were perceived barriers to PrEP-related care, having reduced sexual behaviors and fewer sexual partners, and reduced perceived risk of HIV infection. Limited studies documenting an increase in PrEP uptake were all in specific PrEP optimizing programs. During the pandemic, there is also an emerging trend of switching to on-demand PrEP from daily oral PrEP. Future studies should understand the mechanism of strategies that facilitated the improvements during the pandemic. PrEP implementation programs should consider alternative PrEP modalities and provide consistent and comprehensive knowledge about correct information.
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O’Byrne P, Musten A, Ho N. HIV self-testing in the real world is acceptable for many: post-test participant feedback from the GetaKit study in Ottawa, Canada. J Res Nurs 2022; 27:757-764. [DOI: 10.1177/17449871221137761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: HIV self-testing is the latest strategy to improve access to testing, diagnosis and treatment. Such strategies are beneficial due to the improved individual- and population-level health outcomes that emerge from early HIV diagnosis. Aims: While most research shows that HIV self-testing is acceptable and feasible, yielding higher numbers of first-time testers and positivity rates, compared to clinic-based testing, little evidence exists outside low- and middle-income countries about such testing. Methods: We implemented GetaKit.ca, a website through which eligible participants could register for and obtain an INSTI® HIV self-testing to their home, and then report the result back. Results: Those who returned to the website were asked to complete a post-test survey, which had a low response rate (42%), but identified satisfaction scores of 92%. Notably, 5% of testers sought in-person care after ordering the self-test, and only 80% of participants agreed that the INSTI® HIV self-test was easy to use. Conclusions: Participants provided tangible solutions to improve this test, which we feel are easy to incorporate and essential to maintain HIV self-testing efforts.
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Affiliation(s)
- Patrick O’Byrne
- Nurse Practitioner and Fellow of the American Academy of Nursing, School of Nursing, University of Ottawa, Canada
| | | | - Nikki Ho
- Registered Nurse, School of Nursing, University of Ottawa, Canada
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Labs J, Nunn AS, Chan PA, Bessey S, Park CJ, Marshall BDL, Patel RR, Mena LA, Goedel WC. Projected Effects of Disruptions to Human Immunodeficiency Virus (HIV) Prevention Services During the Coronavirus Disease 2019 Pandemic Among Black/African American Men Who Have Sex With Men in an Ending the HIV Epidemic Priority Jurisdiction. Open Forum Infect Dis 2022; 9:ofac274. [PMID: 35855962 PMCID: PMC9214131 DOI: 10.1093/ofid/ofac274] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background Disruptions in access to in-person human immunodeficiency virus (HIV) preventive care during the coronavirus disease 2019 (COVID-19) pandemic may have a negative impact on our progress towards the Ending the HIV Epidemic goals in the United States. Methods We used an agent-based model to simulate HIV transmission among Black/African American men who have sex with men in Mississippi over 5 years to estimate how different reductions in access affected the number of undiagnosed HIV cases, new pre-exposure prophylaxis (PrEP) starts, and HIV incidence. Results We found that each additional 25% decrease in HIV testing and PrEP initiation was associated with decrease of 20% in the number of cases diagnosed and 23% in the number of new PrEP starts, leading to a 15% increase in HIV incidence from 2020 to 2022. Conclusions Unmet need for HIV testing and PrEP prescriptions during the COVID-19 pandemic may temporarily increase HIV incidence in the years immediately after the disruption period.
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Affiliation(s)
- Jennifer Labs
- Department of Applied Mathematics, Brown University, Providence, Rhode Island, USA
| | - Amy S Nunn
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Philip A Chan
- Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, USA
- Department of Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - S Bessey
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Carolyn J Park
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Brandon D L Marshall
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
| | - Rupa R Patel
- John T. Milliken Department of Internal Medicine, School of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Leandro A Mena
- Department of Population Health Sciences, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William C Goedel
- Department of Epidemiology, School of Public Health, Brown University, Providence, Rhode Island, USA
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Melendez JH, Gilliams EA, Yu T, Williford SL, Armington GS, Silver B, Huebner A, Gaydos CA, Manabe YC, Hamill MM. Rapid Uptake of Testing for Chlamydia, Gonorrhea, and HIV From an Online Platform, April-October 2020. Am J Public Health 2022; 112:985-989. [PMID: 35617664 PMCID: PMC9222452 DOI: 10.2105/ajph.2022.306835] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
The Baltimore City Health Department (Baltimore, MD) promoted IWantTheKit for chlamydia, gonorrhea, and HIV testing to city residents and clinic patients when COVID-19 restricted in-person clinic services. From April to October 2020, monthly online IWantTheKit orders increased by 645%. A high prevalence of chlamydia and gonorrhea was detected, and 96% of users who tested positive for chlamydia and gonorrhea were successfully contacted for treatment. Uptake by Baltimore City Health Department priority populations and excellent treatment linkage demonstrated how a public health-academic partnership successfully addressed a service gap during the pandemic. (Am J Public Health. 2022;112(7):985-989. https://doi.org/10.2105/AJPH.2022.306835).
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Affiliation(s)
- Johan H Melendez
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Elizabeth A Gilliams
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Tong Yu
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Sarah L Williford
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Gretchen S Armington
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Barbara Silver
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Adam Huebner
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Charlotte A Gaydos
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Yukari C Manabe
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
| | - Matthew M Hamill
- Johan H. Melendez, Tong Yu, Sarah L. Williford, Gretchen S. Armington, Barbara Silver, Charlotte A. Gaydos, and Yukari C. Manabe are with the Johns Hopkins School of Medicine, Baltimore, MD. Elizabeth A. Gilliams and Matthew M. Hamill are with the Baltimore City Health Department, Baltimore, MD. Adam Huebner is with the Office of Global AIDS Coordination, US Peace Corps, Washington, DC
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Brennan DJ, Charest M, Turpin A, Griffiths D, Adam BD, Maxwell J, McCrady K, Ahmed R. "It's a win for the clinic, it's a win for the frontline, but, most importantly, it's a win for the client": Task Shifting HIV Prevention Services from Clinicians to Community Health Workers in Ontario, Canada. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 20:780-792. [PMID: 35505827 PMCID: PMC9049009 DOI: 10.1007/s13178-022-00721-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 05/28/2023]
Abstract
Introduction Despite strong evidence from low- and middle-income countries supporting the use of task shifting to provide quality, cost-effective HIV-related health services, this strategy has been adopted less widely in high-income countries such as Canada. Methods In 2020, we conducted semi-structured interviews with 19 clinicians (e.g., psychologists, nurses, physicians) and 14 community health workers (CHWs) in Ontario to examine their perspectives on the prospect of shifting HIV/STBBI testing services and PrEP in Ontario, Canada. Interviews were transcribed and then analyzed using content analysis. A community consultation with key stakeholders was also performed to assess the validity of the findings. Results There was substantial agreement between clinicians and CHWs with respect to shifting specific tasks related to HIV/STBBI testing and PrEP. In particular, most participants felt that rapid HIV testing could and should be provided by CHWs and that ASOs could be ideal sites for clients to obtain and use self-testing kits for STBBIs. Most respondents agreed that CHWs have the skills and expertise required to perform most non-clinical services related to PrEP (e.g., pre-counselling, follow-up, case management). The co-location of clinicians and CHWs could help support the development of task shifting initiatives. Conclusion Findings indicate that there is enthusiasm among both clinicians and CHWs with respect to shifting HIV prevention services. Creative solutions are required to have a meaningful impact on HIV incidence in this population. Policy Implications With adequate training and supervision, non-regulated CHWs should be allowed to provide certain HIV prevention services such as rapid HIV testing. A provincial, publicly funded program for PrEP is recommended.
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Affiliation(s)
- David J. Brennan
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | - Maxime Charest
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON Canada
| | - Aaron Turpin
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. W, Toronto, ON M5S 1V4 Canada
| | | | - Barry D. Adam
- Departments of Sociology, Anthropology and Criminology, University of Windsor, Windsor, ON Canada
- Ontario HIV Treatment Network, Toronto, ON Canada
| | | | - Keith McCrady
- 2-Spirited Peoples of the 1st Nations, Toronto, ON Canada
| | - Robbie Ahmed
- Alliance for South Asian AIDS Prevention, Toronto, ON Canada
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23
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Invalid Results in the GetaKit Study in Ottawa: A Real-World Observation of the INSTI® HIV Self-test Among Persons At Risk for HIV. J Assoc Nurses AIDS Care 2022; 33:567-573. [PMID: 35472138 PMCID: PMC9398507 DOI: 10.1097/jnc.0000000000000335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT HIV self-testing corresponds with more frequent testing, better user satisfaction, and higher positivity rates compared with clinic-based testing. We implemented an open cohort prospective observational study, which provided a website through which persons could do online HIV self-assessments and, if eligible, receive a free HIV self-test. We implemented this project on July 20, 2021 and used the bioLytical INSTI® test. Herein, we describe the number of tests participants reported as invalid, which started at a rate of one fifth of all ordered tests and decreased to 8% after we provided more instructions on completing the test. Our data suggest that a high rate of invalids occur with self-testing in the real-world. Although this has cost implications, we feel this rate is acceptable, considering that 25% of our cohort reported no previous HIV testing. Our take-away message is that HIV self-testing requires additional supports and resources to function as an effective testing intervention.
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Doleeb Z, Tesfaye M, Selk A, Dunn S, Maxwell C. The pandemic and cervical cancer screening: Is it finally time to adopt HPV self-swabbing tests in Canada? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:90-92. [PMID: 35177494 PMCID: PMC9842162 DOI: 10.46747/cfp.680290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Zainab Doleeb
- Fourth-year medical student and a student researcher with the Obstetrics and Gynaecology Equity Committee in the Temerty Faculty of Medicine at the University of Toronto in Ontario.,Correspondence Zainab Doleeb; e-mail
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25
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Doleeb Z, Tesfaye M, Selk A, Dunn S, Maxwell C. La pandémie et le dépistage du cancer du col. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2022; 68:99-102. [PMID: 35177497 PMCID: PMC9842167 DOI: 10.46747/cfp.680299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Zainab Doleeb
- Étudiante en quatrième année de médecine et étudiante chercheuse auprès du Comité d’équité en obstétrique et gynécologie de la Faculté Temerty de médecine de l’Université de Toronto (Ontario).,Correspondance Zainab Doleeb; courriel
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26
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Pollard R, Gopinath U, Reddy YA, Kumar BR, Mugundu P, Vasudevan CK, Srikrishnan AK, Singh A, McFall AM, Mayer KH, Mehta SH, Solomon SS. HIV service delivery in the time of COVID-19: focus group discussions with key populations in India. J Int AIDS Soc 2021; 24 Suppl 6:e25800. [PMID: 34713583 PMCID: PMC8554214 DOI: 10.1002/jia2.25800] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction There are limited data on the impact of COVID‐19‐associated disruptions and novel HIV service delivery strategies among key populations (KPs) in low‐ and middle‐income countries. In March 2020, in response to COVID‐19, the Government of India revised HIV service delivery policies to include community antiretroviral therapy (ART) distribution and multi‐month dispensing (MMD) of ART for all people living with HIV (PLHIV). Methods To assess the acceptability of these adaptations and impact of the pandemic among KPs, we conducted focus groups in November–December 2020 with purposively sampled men who have sex with men (MSM), female sex workers (FSWs) and transgender women (TGW) in Telangana and Maharashtra. Seven discussions were conducted. Topics included HIV service access, risk behaviours, economic security and feedback to ensure service continuity. Inductive coding identified themes across topics. Results Forty‐four individuals aged 20–49 years participated in discussions (13 MSM; 16 FSW; and 15 TGW). Twenty‐four participants self‐identified as living with HIV. People not living with HIV reported challenges in accessing HIV antibody testing at hospitals due to travel restrictions and fear of contracting COVID‐19. Participants accessed HIV antibody testing using transportation arranged by community‐based organizations after lockdowns eased. PLHIV reported uninterrupted ART refills and generally consistent adherence; however, there were experiences of delayed CD4 and HIV RNA testing. Participants shared appreciation for MMD as it saved time, money, and reduced exposure to COVID‐19. Participants expressed gratitude for home deliveries which enabled ART access, yet shared concerns about home‐based services causing confidentiality breaches with family/neighbours. Participants voiced preferences for community‐based service provision due to proximity, convenient hours, and welcoming environments compared to public hospitals. Other requests included support for income, employment, nutrient‐rich food and more accessible mental health, HIV, and other health services. Conclusions COVID‐19 restrictions had a greater impact on access to HIV antibody, CD4, and RNA testing services compared to ART access. High acceptance of MMD and community‐based services support the continued role of differentiated service delivery models to improve KP access to HIV antibody, CD4, RNA testing services, convenient ART retrieval, and integrated services beyond HIV, which may be critical for survival and wellbeing.
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Affiliation(s)
- Rose Pollard
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Usha Gopinath
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Yeruva A Reddy
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Bogam R Kumar
- YR Gaitonde Center for AIDS Research and Education, Chennai, India
| | - Parthasarathy Mugundu
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Aditya Singh
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Allison M McFall
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kenneth H Mayer
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA.,Fenway Health, The Fenway Institute, Boston, Massachusetts, USA
| | - Shruti H Mehta
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sunil S Solomon
- Division of Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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O'Byrne P, Musten A, Orser L, Buckingham S. Automated STI/HIV risk assessments: Testing an online clinical algorithm in Ottawa, Canada. Int J STD AIDS 2021; 32:1365-1373. [PMID: 34507508 PMCID: PMC8649814 DOI: 10.1177/09564624211031322] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite the ongoing transmission of sexually transmitted infections (STIs) and HIV, many people became unable to access testing due to COVID-19. To address this, we created a mail-out HIV self-test kit, which could be delivered without restrictions in our region. The uptake and feedback from this project made us realize that comprehensive STI testing was being sought. To ensure testing occurred correctly-that is, it would be targeted at the persons most affected by STIs/HIV-we automated clinical decision-making. We built this model based on a 2-by-2 matrix that plots the risk of STI/HIV transmission and risk of STI/HIV exposure. The intercept of these two measures classifies a person as low, medium, or high risk. After automating this logic, 16 expert clinicians in STI/HIV care tested this system with over 400 test patient cases and refined the algorithm until it yielded the exact outcomes that these clinicians would offer patients based on guidelines. Findings of interest are that the scale of the y-axis is exponential, in that risk factors for exposure do not climb cumulatively but do so according to a quadratic equation. This helps ensure that testing services are targeted at those who are most inequitably burdened by these infections.
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Affiliation(s)
- Patrick O'Byrne
- School of Nursing, 6363University of Ottawa, Ottawa, ON, Canada
| | | | - Lauren Orser
- School of Nursing, 6363University of Ottawa, Ottawa, ON, Canada
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