Initiative Summary
In Canada, current conventional lab-based screening for key sexually transmitted and blood-borne infections (STBBIs) fails to engage at-risk, marginalized populations. Missed opportunities in early screening and systemic gaps in healthcare delivery, as well as discrimination and stigma, impede timely access to health services, while delayed screening doubles health care costs.
Point-of-care (POC) solutions are needed to address the losses that ensue with such prevailing diagnostic pathways. Although disease management has been aided by available treatments and therapies for many STBBIs such as HIV, HCV, syphilis, there is still the inconvenience that the standard of care for screening of co-infections entails multiple visits and following delays. If rapid POC tests are integrated with mHealth-based (mobile health-based) smart applications, these devices offer a platform for quality screening, patient engagement, communications, linkages to health care and data management, generating a powerful, innovative integrated screening solution. An app-based strategy (app-facilitated multiplex rapid testing with counselling) will facilitate the completion of the multiplex testing process, which includes provision of combined counselling, expedited screening, confirmatory testing, data collection, storage, communication, messaging, and setting up of expedited linkages for continued follow-up and care.
Initiative Objectives and Goals
The primary aim is to evaluate the feasibility of the strategy, which will be assessed by the ‘completion rate’ of the following three key steps: consent/combined counselling; rapid and confirmatory testing; and rapid linkages to counselling and care. Other outcomes are acceptability for the strategy (the number of participants who consent to the strategy over the total number of participants who were approached for the strategy), preferences for counselling (of those participants who consent and complete the strategy how many choose counselling via the app versus in-person), and linkages to counselling and care (computed as a proportion of successful linkages initiated for each infection over the total number of participants who consented to the strategy). We expect to detect new infections of HIV, HCV, syphilis and we expect to link them to treatments in real-time, generating impact data relevant for CIHR and REACH Nexus initiatives. We aim to scale this solution in three provinces with a high burden of undiagnosed infections: Quebec, Manitoba and New Brunswick.
The Role of this Initiative to End the HIV Epidemic
AideSmart! is a novel infection screening and counselling app that simultaneously provides point-of-care tests and a counselling service. It engages participants by linking them to care for timely screening and treatment of HIV and STIs, including Hepatitis B and C viruses, and syphilis. Currently, Canada is behind in achieving the first two UNAIDS (the Joint United Nations Programme on HIV/AIDS) 90-90-90 targets. The difficulty in achieving the first ‘90’ target could possibly be attributed to difficulties in accessing and providing the much-needed tools in diagnostics and treatment to at-risk populations. A rapid, mobile screening solution will help triage patients who are most at-risk as early as possible while maintaining patients engaged in care.
Meaningful Engagement with People with Lived Experience
Frontline healthcare providers involved in providing multiplexed POC testing and counselling services at each site with the AIDESmart! app-based program will offer to the study participant pre-test counselling, multiplexed testing, post-test counselling and linkages to care. Rapid test results will not be declared without receipt of confirmatory lab results and conventional blood tests will be performed to confirm all POC results. The HCPs will then obtain fingerstick blood samples to screen with multiplex POC devices. All participants will return for a second visit, during which both positive and negative test results will be declared in a post-test counselling and harm reduction session utilizing the AIDESmart! app. Patients will then be linked to treatment within a rapid turnaround time.
Region
National
A REACH-Funded Initiative
Initiative Leads
McGill University
Principal co-investigators: Dr. Nitika Pant Pai, Dr. John Kim, Dr. Sean Rourke, Dr. Paramita Saha Chaudhuri, Dr. Duncan Webster
Key performance indicators
Primary target audience
Men who have sex with men (MSM), Indigenous populations, people who engage in injection drug use, and people who have immigrated from endemic countries
Secondary target audience
Other at-risk and/or marginalized populations
Start Date
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Strategic marketing and support tactics
Website, Social networks, Webinar/Seminar
RESULTS
Results This study will generate important data so as to guide future digital access to linkage policies. This strategy is scalable and portable, with the potential to provide timely simultaneous screening of treatable STBBIs in at-risk populations, both in Canada and worldwide. Feasibility of deployment will be documented in real-time before it is tested in a larger clinical trial across Canada. If successful, this strategy could be replicated in primary clinics and pharmacies with key at-risk populations such as MSM and immigrants. The application could be translated into many languages and be used for other vulnerable populations. The strategy is device agnostic, meaning in the future other STIs such as chlamydia, gonorrhea, Hepatitis B, human papillomavirus, and herpes simplex could be integrated, and it is portable – it can be operationalized in all areas (rural, peri-urban and urban) through mobile vans, outreach centres, and community clinics. The idea will be to scale the strategy and make it available Canada-wide. Knowledge translation deliverables include open access manuscripts & scientific conference presentations plain language summaries for lay audiences, guidelines and technical reports (e.g. PHAC, HC, IAPAC), face-to-face meetings/teleconferences with the REACH 3.0 team to disseminate/discuss findings.
Results
This study will generate important data to guide future digital access-to-linkage policies. This strategy is scalable and portable, with the potential to provide timely simultaneous screening of treatable STBBIs in at-risk populations, both in Canada and worldwide. Feasibility of deployment will be documented in real-time before it is tested in a larger clinical trial across Canada. If successful, this strategy could be replicated in primary clinics and pharmacies with key at-risk populations such as MSM and immigrants. The application could be translated into many languages and be used for other vulnerable populations. The strategy is device agnostic, meaning in the future other STIs such as chlamydia, gonorrhea, Hepatitis B, human papillomavirus, and herpes simplex could be integrated, and it is portable: it can be operationalized in all areas (rural, peri-urban and urban) through mobile vans, outreach centres, and community clinics. The idea will be to scale the strategy and make it available Canada-wide. Knowledge translation deliverables include open access manuscripts & scientific conference presentations plain language summaries for lay audiences, guidelines and technical reports (e.g. PHAC, HC, IAPAC), face-to-face meetings/teleconferences with the REACH 3.0 team to disseminate/discuss findings.
Insights
