After the launch of a pharmacy-based testing pilot earlier this year in Ottawa and Ontario, an all-new HIV self-testing program is now underway in Ottawa. People in the city can now order a free INSTI HIV Self Test kit online as part of a the GetaKit pilot from the University of Ottawa.
In collaboration with the AIDS Committee of Ottawa, MAX Ottawa, Ottawa Public Health, and the Ontario HIV Treatment Network (OHTN), the program offers free HIV self-test kits delivered directly to your door. While the INSTI HIV Self Test is not currently available for purchase in Canada, this group of researchers gained special access permission from Health Canada to supply the kits free-of-charge in the local community.
We talked to two of the project’s leads, Alexandra Musten, the Senior Lead, Testing & Clinical Care Initiatives for the OHTN and the Principal Investigator Dr. Patrick O’Byrne, a Full Professor of Nursing at the University of Ottawa and Nurse Practitioner at Ottawa Public Health, about this exciting new program.
Alexandra explains that this has been a long-awaited opportunity to add another HIV testing option in the region, saying, “Self-testing has been a part of the larger discussion on HIV testing in Ontario for a long time. When we learned that a self-test may soon be coming to Canada, we decided start making a plan.”
The Get a Kit program asks people to follow four simple steps: register online, fill out a survey to assess their eligibility, order the INSTI HIV Self Test kit and receive it by mail, and report their result. For the length of the pilot, participants who complete the surveys will receive up to $20 in gift vouchers as thanks. This is to help answer questions around feasibility and acceptability of self-testing.
A program like this requires a collaborative approach and infrastructure to make sure everything runs smoothly. That’s where Patrick’s team came in, says Alexandra. “Once we had put together the admin side of things, we reached out to Patrick and the teams at the University of Ottawa and Ottawa Public Health because we knew they were already offering direct mail out harm reduction services in the community. We knew they could help out with the specifics of this program and advise us on what a direct mail out could look like for self-testing.”
Alexandra adds, “I believe that self-testing adds an extra tool in the toolkit for us, in an area of the country that is already delivering great services.”
For Patrick, mailing self-testing kits was a natural fit with the services that he and his team were already offering, “The STI clinic is operated by Ottawa Public Health and there’s a safe injection site there too. We are already responsible for mailing out condoms and distributing naloxone and safe injection equipment for the entire city, as well as doing client level direct service delivery. People can already order condoms from us online, so it was just a question of adding self-testing kits.”
With strong uptake of the kits since the program launched in late July, Patrick explains that there are a few key ingredients to making a program like this successful. “ You need a team that is invested it, and leaders with the licensure to order the kits,” says Patrick, “Plus, we really benefit from our connections with community partners to make sure we are communicating as effectively as possible and can offer accessible language services for our clients.”
The test kits are currently mailed out in boxes, to help with discreet delivery, but Patrick says one surprising outcome has been people sharing their self-testing experience on social media to raise awareness and encourage others to test. Patrick says, “It’s more than I would have expected, and people are posting on social media to say they like it. People are posting pictures of their kits and of their test results. It’s interesting!”
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The longer-term aim of this pilot is to establish whether a self-test delivery program is feasible to implement in Ottawa . One of the key elements is whether people are successfully linked to care if their test result is reactive, also known as a preliminary positive. Patrick emphasises that the services available for self-testers need to follow a “no door is a wrong door” approach, where nobody is turned away from receiving care and support in any healthcare or outreach setting. Additionally, Patrick says that ensuring the program is “status neutral” means testers will be connected to support whether their result is reactive or non-reactive. This means confirmatory testing and referral to care for anyone who has a reactive test result, and information about and referral for HIV PrEP for anyone with a non-reactive result.
Looking ahead to the future, Patrick says the program will continue to develop and find ways to engage with key priority populations, the groups most impacted by the HIV epidemic. He says, “Our hope is to keep moving forward and refine it until it is a really effective programme.”