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"U = U" is the principle that HIV is untransmittable from people living with an undetectable HIV viral-load. Wide-spread knowledge about U = U is believed to produce public health benefit by reducing HIV-related stigma – promoting wellbeing for people living with HIV. Therefore, we examined the diffusion of U = U with respect to the social position of sexual and gender minority men (SGMM). Participants were SGMM recruited from 16 LGBTQ2S+ pride festivals across Canada. Social position was measured using an index assessing whether participants were (a) trans, (b) a person of colour, (c) Indigenous, (d) born abroad, (e) bisexual or straight, (f) not out, (g) struggling with money, (h) not college educated, (i) and not participating in LGBTQ2S+ Organizations, Queer Pop-ups, or HIV advocacy organizations. Multivariable logistic regression tested whether Index Scores were associated with knowledge about U = U. Among 2681 participants, 72.6% knew about U = U. For HIV-negative/unknown status SGMM, each 1-point increase in Social Positionality Index Scores was associated with a 21% reduction in the odds that they knew about U = U (aOR: 0.79 [0.73, 0.85], per 1-point increase). Results indicate that social marginalization harms the diffusion of HIV-related biomedical knowledge, independent of risk-taking behaviour and other factors. [ABSTRACT FROM AUTHOR]

Background: Clinical prediction rules (CPRs) can be used in sexually transmitted infection (STI) testing environments to prioritize individuals at the highest risk of infection and optimize resource allocation. We previously derived a CPR to predict asymptomatic chlamydia and/or gonorrhea (CT/NG) infection among women and heterosexual men at in-person STI clinics based on 5 predictors. Population differences between clinic-based and Internet-based testers may limit the tool's application across settings. The primary objective of this study was to assess the validity, sensitivity, and overall performance of this CPR within an Internet-based testing environment (GetCheckedOnline.com).Methods: We analyzed GetCheckedOnline online risk assessment and laboratory data from October 2015 to June 2019. We compared the STI clinic population used for CPR derivation (data previously published) and the GetCheckedOnline validation population using χ2 tests. Calibration and discrimination were assessed using the Hosmer-Lemeshow goodness-of-fit test and the area under the receiver operating curve, respectively. Sensitivity and the fraction of total screening tests offered were quantified for CPR-predicted risk scores.Results: Asymptomatic CT/NG infection prevalence in the GetCheckedOnline population (n = 5478) was higher than in the STI clinic population (n = 10,437; 2.4% vs. 1.8%, P = 0.007). When applied to GetCheckedOnline, the CPR had reasonable calibration (Hosmer-Lemeshow, P = 0.90) and discrimination (area under the receiver operating characteristic, 0.64). By screening only individuals with total risk scores ≥4, we would detect 97% of infections and reduce screening by 14%.Conclusions: The application of an existing CPR to detect asymptomatic CT/NG infection is valid within an Internet-based STI testing environment. Clinical prediction rules applied online can reduce unnecessary STI testing and optimize resource allocation within publicly funded health systems. [ABSTRACT FROM AUTHOR]

Background: Some individuals engaging with online STBBI testing services do not complete testing (i.e., submit specimens) for poorly understood reasons. If individuals needed testing at the time, these may reflect missed opportunities for testing that can be potentially overcome by improvements in service design or implementation. We studied this question among people creating an account on GetCheckedOnline, British Columbia's online STBBI testing service where users generate lab forms to take to local labs for specimen collection. Methods: Between Nov 21 - Dec 6, 2022, we invited users of GetCheckedOnline to an online survey who had consented to be contacted for research, were ≥ 16 years, and had created an account in the past 6 months. We descriptively analyzed the characteristics of participants needing but not completing testing (excluding missing responses). Results: Overall, 3128 account holders were invited and 681 (22%) completed the survey, of whom 84% (572/681) needed testing at account creation (Figure 1). Of the 183 (32% of 572) needing but not completing testing, 62% (98/159) identified as women, 48% (77/159) with a non-heterosexual sexual identity, and 32% (51/159) with an ethnicity other than White. Approximately 37% (58/157) agreed provider-based testing was easily accessible, and 36% (57/158) agreed they had a usual place where they were comfortable getting tested by a provider. Reasons for not proceeding to test through GetCheckedOnline included (n=170): choosing provider-based testing instead (e.g., wanting to speak to a provider; 26%), challenges with the testing process at the laboratory (e.g., not being able to print/display form; 21%), not getting around to taking forms to a lab (19%), no nearby lab (16%), not understanding how the service/process worked (9%), and dissatisfaction with the tests offered (e.g., other tests sought, 8%). Overall, 86% (138/161) agreed they would test through GetCheckedOnline in the future. Conclusion: While some people needing but not testing through GetCheckedOnline accessed testing through other means, many reported challenges related to the design and implementation of the service. Similar studies can help identify how online testing services may be improved (e.g., for GetCheckedOnline, improving instructions or adding text/email reminders to submit specimens or selfcollected sampling kits). [ABSTRACT FROM AUTHOR]

Background: Gay, bisexual and other men who have sex with men (gbMSM) experience high rates of sexually transmitted infections (STIs). Novel assessments of the antibiotic doxycycline have demonstrated high efficacy and acceptability as preexposure prophylaxis (PrEP) for reducing STIs. As interest in clinical implementation grows, there is a need to understand patient variables that facilitate uptake. We aimed to determine the prevalence and correlates of wanting to take STI-PrEP among gbMSM in British Columbia (BC), Canada. Methods: Using the online Sex Now survey, gbMSM aged 15+ were recruited through sociosexual networking apps and social media advertisements from 11/2019--02/2020. Participants provided demographic details pertaining to sexual behaviours, STI history, and HIV-PrEP use. They then responded to a module on STI-PrEP, created using the theory of planned behaviour. Bivariate logistic regression assessed variables associated with wanting to take STI-PrEP. Results: Among 296 participants, 97 (32.7%) wanted to take STI-PrEP. Participants were mostly white (77.8% [228/293]), with a mean age of 39.1 years. Those with >10 sexual partners in the previous six months experienced higher odds of wanting to take STI-PrEP (odds ratio [OR] 2.89, 95% confidence interval [CI] 1.61, 5.18). Odds of wanting to take STIPrEP were elevated for participants who were single (OR 2.76, 95% CI 1.31, 5.85) or in open relationships (OR 4.23, 95% CI 1.96, 9.13), compared with monogamous participants. Those with a history of using HIV-PrEP had higher odds of wanting to take STI-PrEP (OR 3.00 95% CI 1.76, 5.14). Participants with past-year diagnoses of syphilis (OR 7.20, 95% CI 1.47, 35.4) or gonorrhea (OR 2.62, 95% CI 1.25, 5.47) had increased odds of wanting to take STI-PrEP. Those who reported condomless anal sex in the previous six months had elevated odds of wanting to take STI-PrEP (OR 2.08, 95% CI 1.26, 3.44). There were no associations with age, HIV status, or pastyear chlamydia diagnosis and wanting to take STIPrEP. Conclusion: Individuals with more sexual partners, previous STIs, histories of PrEP use and condomless anal sex had higher odds of wanting to take STI-PrEP. Understanding STI-PrEP desirability helps inform clinical indications, economic analyses and public health planning. [ABSTRACT FROM AUTHOR]

Background: Mpox vaccination campaigns for transgender people and gay, bisexual and other men who have sex with men (T/GBM) were the primary public health strategy for controlling the 2022 Mpox outbreak. In British Columbia (BC), Mpox prevention and control measures including vaccination were implemented in close partnership with T/GBM organizations and providers from the start of the outbreak. We measured vaccine uptake and associated factors among T/GBM clients of an urban STI clinic in Vancouver, BC. Methods: We conducted a cross-sectional online survey between August 8-22, 2022, 5-7 weeks following the launch of a first-dose Mpox vaccination campaign targeting T/GBM populations. We invited all STI clinic clients in the past 3 years who consented to be contacted for research. Survey domains included vaccine outcomes, mpox knowledge, beliefs, cues to action, and psychological antecedents of vaccination. Using bivariate analyses we examined whether these factors were associated with vaccine uptake among vaccine-eligible T/GBM. Results: Of 3,930 clients invited, 27% (946) participated in the survey. Of the 331 T/GBM participants: the majority were White, university educated, identified as a man and gay; 10% had trans experience. Overall, 51% had been vaccinated (167/325); 68% (222/326) were eligible for vaccination, of whom 66% (146/222) had been vaccinated. Being unvaccinated was significantly more common among participants identifying as bisexual or heteroflexible/mostly straight, and who spent less time with other T/GBM. Eligible yet unvaccinated participants had lower perceived susceptibility, and reported fewer cues to action (e.g., fewer saw information promoting the vaccine), and increased constraints to vaccine access; vaccine barriers related to accessing clinics and privacy were common. The majority (85%, 64/75) of those eligible and unvaccinated at time of survey were willing to receive the vaccine. Conclusion: In this sample of STI clinic clients, vaccine uptake among eligible T/GBM was high in the initial weeks following a Mpox vaccination campaign. However, uptake was patterned on social gradients with lower uptake among T/GBM who may be less effectively engaged by available promotion channels. Intentional and ongoing engagement of diverse T/GBM groups is key in Mpox and other targeted vaccination programs to this population. [ABSTRACT FROM AUTHOR]

Background: Implementation outcomes within populations are key to assessing the impact of online testing services, but are not commonly measured. GetCheckedOnline, British Columbia's online sexually-transmitted and blood-borne infection (STBBI) testing service, is being scaled up in the province, with two waves of expansion from Vancouver to seven urban, suburban and rural communities. We assessed post-expansion reach (awareness), use, and intention to use in these communities. Methods: Between July-Sept 2022, we conducted a cross-sectional survey in each community, recruiting in-person and online with oversampling among populations affected by STBBI. Eligible participants were ³16 years old, sexually active, and BC residents. Questions evaluated awareness, use, and intention to use GetCheckedOnline; these outcomes and key sample characteristics are described. Results: 1657 eligible individuals were recruited, of whom 67.0% (1099/1641) identified as White, 10.2% (151/1477) as trans and 53.0% (793/1496) as nonheterosexual. Mean age was 33 years (SD 11.8); 39.1% (566/1447) had used illegal/non-prescribed drugs (past year), and 21.5% (315/1466) had ever been homeless. A fifth (20.7%, 319/1543) had never tested for STBBIs, and 66.8% (990/1483) reported experiencing barriers accessing providers for testing in the past year (e.g., long wait times). Almost half (45.1%, 663/1470) reported 3 or more sexual partners (last year), and 35.1% (520/1479) had ever been diagnosed with an STBBI, of whom 29.2% (102/349) had their most recent diagnosis during last year. Overall, 35.8% (584/1633) were aware of GetCheckedOnline, of whom 56.3% had used the service (324/576). These outcomes varied by wave of expansion: in Wave 1 communities (2016) awareness was 39.6% and use among aware was 60.1% versus 18.1% and 38.3% in Wave 2 communities (2019- 2020), respectively. For 91.1% of participants (1334/1465), it was very easy/easy to go online when needed, and 63.1% (1020/1616) were very likely/likely to use GetCheckedOnline in the future. Conclusion: Our study suggests GetCheckedOnline is improving access to STBBI testing in these communities, with half of people aware of the service using it in a sample where barriers to accessing provider-based testing were common. However, only a third of participants were aware of the service, and further promotion of GetCheckedOnline to increase reach may be beneficial. [ABSTRACT FROM AUTHOR]

Background: As the scale-up of online testing services for sexually transmitted and bloodborne infections (STBBI) continues to change the testing landscape, questions remain about how people use these services in relation to provider-based testing. We surveyed repeat users of GetCheckedOnline, Canada's only online STBBI testing service, about their concurrent use of provider-based testing services. Methods: We invited users of GetCheckedOnline who had consented to be contacted for research, were 16 years or older, and had tested at least twice through the service (once in the past 6 months) to complete an online survey between November 21-December 6, 2022. Results are presented descriptively. Results: Among 789 survey respondents (44% of those invited), 44% identified as men, 38% identified as straight/heterosexual, and 68% identified as White. Over half (57%) usually tested at least every 3-4 months and the majority (79%) usually sought STBBI testing through GetCheckedOnline. Of 384 participants who did not exclusively test through GetCheckedOnline, reasons for seeking providerbased testing over GetCheckedOnline included during health visits for other reasons (50%), needing to speak to providers about sexual health (35%), testing as part of HIV treatment or PrEP (27%), needing tests not offered through GetCheckedOnline (26%), experiencing symptoms (29%), or having had a partner with an STI (14%). Most (86%) agreed they test more often because of GetCheckedOnline, and 88% agreed that GetCheckedOnline allowed them to test sooner than through a provider. If GetCheckedOnline had not been available, most (89%) would have accessed provider-based testing; however, 11% (80/747) would not have sought further testing. Almost all would recommend GetCheckedOnline to others and would test again using GetCheckedOnline in the future (99% and 99%, respectively). Conclusion: Our findings suggest that most repeat users had shifted all or part of their current testing to GetCheckedOnline, which they perceived as facilitating more frequent and earlier testing. GetCheckedOnline is highly acceptable to its repeat users and, for some, is the only testing option they used or would consider using. Our findings position online STBBI testing as an important complement to provider-based services and suggest that online testing services may help alleviate demands on provider-based testing services. [ABSTRACT FROM AUTHOR]