(P327) Rationale and design of the STBBI-CARE [community/access/respect/equity] Pilot Study: a web-based platform to enhance community access to comprehensive, at-home STBBI testing for at-risk populations

Background: Sexually transmitted and blood-borne infections (STBBI) remain a significant public health concern in Canada with a continued rise in incidence since the 1990s despite public health efforts to address these issues. In Canada, infection rates of Chlamydia trachomatis (CT), N. gonorrhoeae (GC), and infectious syphilis (STS) rose by 33%, 182%, and 393%, respectively, between 2010 and 2019. Many demographical, socio-cultural, and epidemiologic factors may be contributing to this ongoing rise and speak to the urgent need for a holistic and collaborative approach to diagnose, treat, and prevent STBBIs. Further, despite the advances in STBBI diagnostics, remote testing options are not available for Canadians who are most at risk.

Methods: The Center for Sexuality (C4S) gbMSM STBBI clinic will serve as the setting for this prospective pilot study that seeks to enroll 1,000 patients (16 years and older) recruited from across Alberta, Canada. Participants will access a secure, online questionnaire developed through patient engagement that will collect information on demographics, sexual, medical, and STBBI history, and items on perceived barriers and stigma relating to STBBI care. Participants will be mailed an anatomy/behaviour specific STBBI testing kit (urine or vaginal/throat/rectal swabs for CT/GC/T.vaginalis and Dried Blood Spot for STS/HIV/HBV/HCV) with self-collection instructions and return envelope before being asked to complete online post-testing, diagnosis, treatment (as applicable) questionnaires to provide feedback and further assess STBBI care facilitators and barriers. The study is powered to detect a doubling of C4S clinic testing volumes.

Results [Objective]: To describe the rationale for a study of a web-based platform with comprehensive mail-out testing to at-risk persons with aims to (1) evaluate the effectiveness the web-based care platform in increasing testing rates among at-risk individuals and (2) to evaluate the access barriers to STBBI testing and treatment.

Conclusions: This interdisciplinary endeavour by clinical and laboratory physicians, knowledge users, administrators, and care providers represents an opportunity to innovate STBBI care in Canada to counter rising infection rates. This study will help inform future redevelopment of a STBBI care conceptual framework for at-risk persons and provide necessary evidence for health system investment in patient-initiated, comprehensive self-testing to expedite STBBI care.