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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.

IntroductionThe rates of gonorrhea and chlamydia have been increasing in the years preceding the COVID19 pandemic. Because most gonorrhea and chlamydia infections are located in the oropharynx and rectum for men who have sex with men (MSM), and because at-home self-collected swabs for these infections are not licensed by Health Canada or the United States Food and Drug Administration, decreased accessed to in-person care during and since the COVID19 pandemic potentially means missed case findings.ObjectivesTo evaluate the performance of at-home self-collected pharyngeal and rectal swabs for gonorrhea and chlamydia nucleic acid amplification testing.MethodologyAll persons who contacted our Sexual Health Clinic and who had a clinical indication to complete oral and/or rectal swabs for gonorrhea and chlamydia were invited to complete at-home swabs in advance of their scheduled appointments. We mailed swabs and instructions to those who consented. Participants brought these swabs to their scheduled in clinic appointments, where we repeated the same swabs. All matching swabs were sent to the laboratory for analysis to determine concordance.ResultsFrom September 8, 2022 to July 18, 2023, we enrolled 296 eligible participants who provided 1184 swabs. For analysis, cancelled specimens and specimens with invalid results were excluded, leaving 1032 swabs for comparison. We identified 66 STI diagnoses in 47 unique participants. Overall accuracy was high (exceeding 99%), except for rectal chlamydia, which was 96.0%. While the performance of self-swabs for chlamydia was lower compared to gonorrhea, at-home swabs identified six chlamydia infections that were missed by in-clinic collected swabs (two pharyngeal, four rectal). Removing these six cases as "false positives" increased overall accuracy for chlamydia detection to 99.7% (pharyngeal) and 97.8% (rectal).ConclusionSelf-collected at-home swabs had good performance acceptable for gonorrhea and chlamydia nucleic acid amplification testing.

COVID-19 self-testing strategy (COVIDST) can rapidly identify symptomatic and asymptomatic SARS-CoV-2-infected individuals and their contacts, potentially reducing transmission. In this living systematic review, we evaluated the evidence for real-world COVIDST performance. Two independent reviewers searched six databases (PubMed, Embase, Web of Science, World Health Organization database, Cochrane COVID-19 registry, Europe PMC) for the period April 1st, 2020, to January 18th, 2023. Data on studies evaluating COVIDST against laboratory-based conventional testing and reported on diagnostic accuracy, feasibility, acceptability, impact, and qualitative outcomes were abstracted. Bivariate random effects meta-analyses of COVIDST accuracy were performed (n = 14). Subgroup analyses (by sampling site, symptomatic/asymptomatic infection, supervised/unsupervised strategy, with/without digital supports) were conducted. Data from 70 included studies, conducted across 25 countries with a median sample size of 817 (range: 28-784,707) were pooled. Specificity and DOR was high overall, irrespective of subgroups (98.37-99.71%). Highest sensitivities were reported for: a) symptomatic individuals (73.91%, 95%CI: 68.41-78.75%; n = 9), b) mid-turbinate nasal samples (77.79%, 95%CI: 56.03-90.59%; n = 14), c) supervised strategy (86.67%, 95%CI: 59.64-96.62%; n = 13), and d) use of digital interventions (70.15%, 95%CI: 50.18-84.63%; n = 14). Lower sensitivity was attributed to absence of symptoms, errors in test conduct and absence of supervision or a digital support. We found no difference in COVIDST sensitivity between delta and omicron pre-dominant period. Digital supports increased confidence in COVIDST reporting and interpretation (n = 16). Overall acceptability was 91.0-98.7% (n = 2) with lower acceptability reported for daily self-testing (39.5-51.1%). Overall feasibility was 69.0-100.0% (n = 5) with lower feasibility (35.9-64.6%) for serial self-testing. COVIDST decreased closures in school, workplace, and social events (n = 4). COVIDST is an effective rapid screening strategy for home-, workplace- or school-based screening, for symptomatic persons, and for preventing transmission during outbreaks. These data will guide COVIDST policy. Our review demonstrates that COVIDST has paved the way for self-testing in pandemics worldwide.

To create health promotion programs and clinical guidelines inclusive of gay, bisexual and other men who have sex with men (gbMSM), a better understanding of the health and social determinants that influence health outcomes for these men is required. Health research on gbMSM, however, has focused primarily on sexual health and HIV (human immunodeficiency virus) with most information coming from men living in large urban centers. To address this limitation and better characterize the overall health of this population, we conducted a survey of gbMSM living in Eastern Ontario, Canada. The survey, completed anonymously, was available from June to October 2015. A total of 674 gbMSM completed the survey; 61% were urban, 23% suburban and 16% lived in small towns or rural settings. The average age was 44.2 years, ranging from 18 to 83 years. Healthcare engagement was high for all groups of gbMSM, though disclosure of sexual orientation to healthcare providers varied based on the gender of sexual partners. Urban men tended to be younger, sexually active only with men, open about their sexual orientation, and more likely to use recreational drugs while men living in small towns and rural settings tended to be older, bisexual and more likely to conceal their sexual orientation. While the physical health of respondents was on par with national averages for men, we found younger men were more likely to suffer from anxiety and use recreational drugs while older men were more likely to develop problem alcohol use. Depressive symptoms were high across all demographic groups. Our data demonstrate that while gbMSM in Eastern Ontario have a high degree of contact with the healthcare system, considerable health inequities remain unaddressed. We also find significant health differences among gbMSM depending on age, area of residence, and degree of disclosure of sexual orientation.

Abstract Background As the overdose crisis in Canada continues to escalate in severity, novel interventions and programs are required. Safer Supply programs offer pharmaceutical-grade medication to people who use drugs to replace and decrease harms related to the toxic illicit drug supply. Given the paucity of research surrounding these programs, we sought to better understand the experience of being part of a Safer Supply program from the perspective of current participants. Methods We completed semi-structured interviews and surveys with Safer Supply participants in Ottawa, Canada. Interviews were audio-recorded, transcribed, and analyzed thematically. Descriptive statistics were used to report survey data. Results Participants most commonly discussed Safer Supply benefits. This included programs offering a sense of community, connection, hope for the future, and increased autonomy. Participants also described program concerns, such as restrictive protocols, inadequate drugs, and diversion. Conclusions Our research demonstrated that participants found Safer Supply to be effective and impactful for their substance use goals. While participants did discuss concerns about the program, overall, we found that this is an important harm reduction-based program for people who use drugs in the midst of the overdose crisis.

Background: The incidence of infectious syphilis in Canada has declined throughout the latter decades of the last century; however, in Ottawa, an upsurge in new cases began in 2001. The local epidemic continues to involve predominantly gay, bisexual and other men who have sex with men (gbMSM), but in recent years, has expanded further into heterosexual populations. This has coincided with an increase in the number of pregnant women testing positive for syphilis on antenatal screening. The aim of this study is to understand the changing epidemiology in infectious syphilis cases diagnosed in Ottawa to strengthen primary care management and public health response. Methods: Surveillance data from the Ontario Ministry of Health were used to describe the evolving epidemiology of infectious syphilis in the Ottawa region from 2010 to 2019, including a comprehensive chart review of cases from 2015–2019. Results: The number of cases of infectious syphilis in Ottawa rose from 50 cases in 2010 to 171 cases in 2019. These rates were consistently high among males, and increased from 10.9/100,000 in 2010 to 30.9/100,000 in 2019. The rates among females, in comparison, increased from 0.4/100,000 in 2010 to 3.2/100,000 in 2019, with corresponding increases during antenatal screening (with no congenital syphilis cases to date). Conclusion: As the syphilis epidemic continues to evolve in Ottawa, ongoing surveillance plays a crucial role. Public health resources must address the needs of populations already impacted but at the same time be flexible enough to respond to changes in trends and support clinicians providing care to populations where the epidemic is emerging.

Contexte : L’incidence de la syphilis infectieuse au Canada a diminué au cours des dernières décennies. Cependant, on observe une augmentation du nombre de nouveaux cas depuis 2001 à Ottawa. L’épidémie locale touche principalement des hommes gais, bisexuels et autres hommes ayant des relations sexuelles avec des hommes (gbHARSAH), mais ces dernières années, elle s’est étendue à des populations hétérosexuelles. La propagation a coïncidé avec une augmentation du nombre de femmes enceintes ayant obtenu un résultat positif au test de dépistage de la syphilis lors du dépistage prénatal. Cette étude vise à comprendre l’évolution de l’épidémiologie des cas de syphilis infectieuse diagnostiqués à Ottawa afin de renforcer la gestion des soins primaires et l’intervention en santé publique. Méthodes : Des données de surveillance du ministère de la Santé de l’Ontario ont été utilisées pour décrire l’évolution de l’épidémiologie de la syphilis infectieuse dans la région d’Ottawa de 2010 à 2019, notamment un examen complet des dossiers des cas de 2015 à 2019. Résultats : Le nombre de cas de syphilis infectieuse à Ottawa est passé de 50 cas en 2010 à 171 cas en 2019. Ces taux étaient toujours élevés chez les hommes et sont passés de 10,9/100 000 habitants en 2010 à 30,9/100 000 habitants en 2019. En comparaison, les taux chez les femmes sont passés de 0,4/100 000 habitantes en 2010 à 3,2/100 000 habitantes en 2019, avec des augmentations correspondantes pendant le dépistage prénatal (aucun cas de syphilis congénitale à ce jour). Conclusion : La surveillance continue joue un rôle crucial alors que l’épidémie de syphilis continue d’évoluer à Ottawa. Les ressources en santé publique doivent répondre aux besoins des populations déjà touchées, en plus d’être suffisamment souples pour réagir aux changements de tendances et appuyer les cliniciens qui fournissent des soins aux populations touchées par l’épidémie.

Abstract Background While HIV pre-exposure prophylaxis (PrEP) has become more readily available in Canada, its uptake among HIV priority populations continues to be affected by system-level and individual factors. Such impediments relate to challenges by healthcare providers in assessing HIV-related risk and variability in patients’ motivations for PrEP initiation and continued engagement in care. Methods In Ottawa, Canada, a group of researchers implemented Canada’s first nurse-led HIV prevention program, known as PrEP-RN. As part of this pilot, qualitative interviews were completed with fourteen patients who had accessed PrEP-RN. The purpose of these interviews was to understand participants’ perspectives related to HIV prevention and experiences accessing care through a nurse-led service. Interviews were analyzed using thematic analysis, which were organized into the two major themes of (1) motivations for PrEP initiation and (2) beliefs about the benefits of PrEP. Results Findings revealed participants’ motivations for PrEP differed from healthcare provider’s views of risk, which were influenced by external life factors and personal perceptions of risk. In addition, participants discussed the benefits of PrEP in terms of its ability to manage their potential mistrust of sexual partners, control their sexual health, and liberate fears and anxieties related to HIV. Conclusions Based on these findings, health and allied providers should consider incorporating individual motivations and beliefs into patient education and counselling about PrEP to better target HIV prevention care at persons are at elevated risk of HIV. These perspectives could also be used to re-structure web and social media campaigns to increase PrEP uptake among HIV priority populations.

IntroductionIn 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.ObjectivesTo (1) gather patients' sentiments and experiences related to nurse-led PrEP and (2) identify the implications for nurses working in sexual healthcare.MethodologyQualitative 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.ResultsOur 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.ConclusionThese 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.

Contexte : L’Agence de la santé publique du Canada estime qu’environ 87 % des personnes vivant avec le virus de l’immunodéficience humaine (VIH) au Canada ont été diagnostiquées, ce qui est bien en deçà de l’objectif du Programme commun des Nations Unies sur le VIH/sida de faire diagnostiquer 95 % des personnes séropositives. La recherche a montré que l’auto-test du VIH peut aider à augmenter ces diagnostics, en particulier parmi les populations les plus touchées par le VIH. L’objectif de l’étude était de déterminer les résultats de l’adoption et du diagnostic associés à l’auto-test gratuit du VIH. Méthodes : Nous avons élaboré le premier programme d’auto-test du VIH gratuit en ligne au Canada et l’avons mis en œuvre à Ottawa. Ce projet a été réalisé en collaboration avec le site Web www.GetaKit.ca. Nous avions l’intention de recruter de 150 à 400 participants sur une période de 6 à 12 mois, en estimant que ce nombre donnerait de 0 à 1 résultats positifs (le taux de positivité prévu est de 0,08 %). Résultats : Entre le 20 juillet 2020 et le 1er avril 2021, 1 268 personnes ont consulté le site Web de GetaKit et vérifié leur admissibilité. Au total, 600 personnes étaient admissibles et 405 ont commandé une trousse de dépistage du VIH. Parmi ceux qui ont commandé une trousse, 399 ont rempli un questionnaire de référence. Dans l’ensemble, 71 % de ces participants étaient membres des groupes prioritaires de lutte contre le VIH. Pour ce qui est des résultats de test, 228 personnes ont déclaré des résultats de test, dont un était positif, soit un taux de positivité de 0,24 % au total et de 0,44 % des résultats déclarés. Ces taux dépassent ceux qui sont normalement observés à Ottawa. Conclusion : L’auto-test du VIH peut être efficacement mis en œuvre par l’accès à un site Web. Une telle intervention sera également utilisée par les personnes atteintes d’infections non diagnostiquées et il semble que cette utilisation se fasse à un taux supérieur à celui observé par les autres moyens de dépistage. L’auto-test du VIH pourrait donc aider le Canada à atteindre les cibles 95-95-95 des Nations Unies.

Background: The Public Health Agency of Canada estimates that about 87% of persons living with human immunodeficiency virus (HIV) in Canada have been diagnosed, which is well below the Joint United Nations Programme on HIV/AIDS target to have 95% of HIV-positive persons diagnosed. Research has shown that HIV self-testing may help increase such diagnoses, especially among the populations who are most affected by HIV. The objective of the study was to determine the uptake and diagnosis outcomes associated with free HIV self-testing. Methods: We developed the first online mailout free HIV self-testing program in Canada and implemented it in Ottawa. This project ran through the website, www.GetaKit.ca. We intended to recruit 150–400 participants over a 6–12-month period, estimating that this number would yield between 0–1 positive test results (expected positivity rate of 0.08%). Results: Between July 20, 2020 and April 1, 2021, 1,268 people accessed the GetaKit website and verified their eligibility. In total, 600 persons were eligible and 405 ordered an HIV kit. Of those who ordered a kit, 399 completed a baseline survey. Overall, 71% of these participants were members of HIV priority groups. For test results, 228 persons reported test results, with one being positive, for a positivity rate of 0.24% overall and 0.44% of reported results. These rates exceed that normally observed in Ottawa. Conclusion: Self-testing of HIV can be effectively delivered through a website. Such an intervention will also be used by persons with undiagnosed infections and appears to do so at a rate higher than that observed by other means of testing. Self-testing of HIV may therefore help Canada achieve the United Nations 95-95-95 targets.

Introduction: HIV pre-exposure prophylaxis (PrEP) is an effective intervention for preventing HIV infections yet is largely unknown to and underutilized among people who use drugs. Methods: To better provide services to this group, we present a prospective, single-group interventional study involving the creation of a partnership between a safer opioid supply program and an HIV PrEP program, both of which were nurse-led. Results: Overall, HIV PrEP was offered to 42 individuals within the safer opioid supply program, resulting in 55% ( n = 23) acceptance. Almost half of the group that accepted PrEP identified as female, and nearly all participants were homeless and did not have a primary care provider. While it was challenging to obtain routine PrEP follow-up labs per guideline recommendations due to poor venous access, most participants were able to successfully stay on PrEP and maintained good medication adherence. There were no PrEP discontinuations due to renal impairment and no participants tested positive for HIV. Conclusion: This novel integration of programs appeared to be a highly effective way to expand access to HIV prevention among people who use drugs. Given the historical and current mistreatment of people who use drugs within the healthcare system, rapport and trust were essential to the uptake of HIV PrEP services. Further, the importance of infectious disease screening among people who use drugs is underscored, and built-in program flexibility and low barrier access is essential.

Injection drug use has long been a topic of investigation, whether through a health or criminal justice lens. Whilst these bodies of literature offer important perspectives, missing from the extant literature is evidence, particularly involving women who use drugs, and more specifically evidence about the health beliefs of these women. To address this knowledge gap, we undertook an ethnographic study of homeless women in downtown Ottawa who inject drugs. This included interviews, observations, and artifact analyses. In this paper, we report on these ethnographic data to show the context and nature of the subjective lives of women who use injection drugs and their beliefs and perspectives on health. We use these data to make recommendations for nursing and healthcare practice moving forward.

Objective To report the results of a nurse-led pre-exposure prophylaxis (PrEP) delivery service.Design This was a prospective cohort study conducted from 5 August 2018 to 4 March 2020. It involved manual chart review to collect data. Variables were described using frequencies and percentages and analysed using χ2 testing. Those significant in bivariate analysis were retained and entered into a binary multiple logistic regression. Hierarchical modelling was used, and only significant factors were retained.Setting This study occurred in an urban public health unit and community-based sexually transmitted infection (STI) clinic in Ottawa, Canada.Participants Of all persons who were diagnosed with a bacterial STI in Ottawa and everyone who presented to our STI clinic during the study period, there were 347 patients who met our high-risk criteria for PrEP; these criteria included patients who newly presented with any of the following: HIV contacts, diagnosed with a bacterial STI or single use of HIV PEP. Further, eligibility could be determined based on clinical judgement. Patients who met the foregoing criteria were appropriate for PrEP-RN, while lower-risk patients were referred to elsewhere. Of the 347 patients who met our high-risk criteria, 47% accepted and 53% declined. Of those who accepted, 80% selected PrEP-registered nurse (RN).Primary and secondary outcome measures Uptake, acceptance, engagement and attrition factors of participants who obtained PrEP through PrEP-RN.Findings 69% of participants who were eligible attended their intake PrEP-RN visit. 66% were retained in care. Half of participants continued PrEP and half were lost to follow-up. We found no significant differences in the uptake, acceptance, engagement and attrition factors of participants who accessed PrEP-RN regarding reason for referral, age, ethnicity, sexual orientation, annual income, education attainted, insurance status, if they have a primary care provider, presence or absence of depression or anxiety and evidence of newly acquired STI during the study period.Conclusions Nurse-led PrEP is an appropriate strategy for PrEP delivery.

Acoustic emissions from current energy converters remain an environmental concern for regulators because of their potential effects on marine life and uncertainties about their effects stemming from a lack of sufficient observational data. Several recent opportunities to characterize tidal turbine sound emissions have begun to fill knowledge gaps and provide a context for future device deployments. In July 2021, a commercial-off-the-shelf hydrophone was deployed in a free-drifting configuration to measure underwater acoustic emissions and characterize a 25 kW-rated tidal turbine at the University of New Hampshire’s Living Bridge Project in Portsmouth, New Hampshire. Sampling methods and analysis were performed in alignment with the recently published IEC 62600-40 Technical Specification for acoustic characterization of marine energy converters. Results from this study indicate acoustic emissions from the turbine were below ambient sound levels and therefore did not have a significant impact on the underwater noise levels of the project site. As a component of Pacific Northwest National Laboratory’s Triton Field Trials (TFiT) described in this Special Issue, this effort provides a valuable use case for the IEC 62600-40 Technical Specification framework and further recommendations for cost-effective technologies and methods for measuring underwater noise at future current energy converter project sites.

Patients who use post-exposure prophylaxis (PEP) are at ongoing risk for HIV acquisition after completing PEP. While the Centers for Disease Control and Prevention recommends pre-exposure prophylaxis (PrEP) use immediately after PEP, some practitioners are hesitant to offer PEP-to-PrEP (PEP2PrEP). We began offering PEP2PrEP in the sexually transmitted infection clinic in Ottawa, Canada on August 5, 2018. During the first 16 months of PEP2PrEP, 61 patients requested PEP and 46 were initiated; 30 of these patients agreed to PEP2PrEP and 26 followed through. None of our PEP patients had confirmed HIV exposures; all fulfilled the initiation criterion of condomless anal sex with a male partner of unknown HIV-status. During the study, the number of PEP requests and initiations was statistical unchanged, yet the seroconversion rate among patients who used PEP decreased from 1.7% pre-PEP2PrEP to 0% post-PEP2PrEP. Regarding follow-up, most discontinuations occurred between the PrEP intake and 1-month follow-up visit.

In the context of increasing syphilis incidence in many Western countries, we sought to better understand the frequency and outcomes associated with inconclusive serologic syphilis results. To accomplish this, we reviewed all inconclusive results that arose from an indeterminant confirmatory treponemal screen (specifically the Treponema pallidum particulate agglutination test), which were reported to Ottawa Public Health from January 1, 2019, through December 31, 2019. Our case review identified that 52 persons generated such test results during the study period, of whom 44.4% were cases requiring treatment, 46.3% were persons without new risk factors or symptoms of syphilis who had been previously treated for this infection, and 9.3% were not syphilis. Overall, these untreated syphilis cases accounted for 8.6% of all new syphilis diagnoses in our local jurisdiction during the study period. These results highlight that case investigation and prompt management of inconclusive syphilis results is an appropriate public health and clinical approach and that such a strategy could contribute to efforts to reduce increasing syphilis incidence.

HIV pre-exposure prophylaxis (PrEP) is an efficacious pharmacologic HIV prevention strategy aimed at persons who are high-risk for HIV infection. Historically, PrEP uptake has been limited by systems-level barriers relating to the high cost of medications and few prescriber access points. In Ottawa, a team of researchers and clinicians sought to increase PrEP access to priority groups by implementing a fully nurse-led PrEP service, known as PrEP-RN, as part of the public health unit's sexual health clinic. This program was the first of its kind in Canada and required consideration from multiple stakeholders within the public health unit, and the Ottawa community. Patients at highest risk for HIV acquisition were offered a referral to PrEP-RN through a provider-driven, active-offer process by public health nurses, and medication coverage was provided to uninsured patients to ensure equal access to PrEP services. Preliminary results showed a 40% uptake of PrEP referrals among high-risk patients, demonstrating that this reform has been effective at reaching some priority groups; however, many persons continue to decline PrEP due to individual perceptions of risk (i.e., feeling they do not need this HIV prevention intervention). La prophylaxie pré-exposition au VIH (PrEP) est une stratégie pharmacologique efficace de prévention du VIH destinée aux personnes à haut risque d'infection par le VIH. Historiquement, l'adoption de la PrEP a été limitée par des obstacles au niveau des systèmes liés au coût élevé des médicaments et par le nombre réduit de points d'accès pour les prescripteurs. À Ottawa, une équipe de chercheurs et de cliniciens a cherché à améliorer l'accès de la PrEP aux groupes prioritaires en mettant en place un service de PrEP dirigé par une infirmière, appelé PrEP-RN, dans le cadre de la clinique de santé sexuelle du bureau de santé publique. Ce programme était le premier du genre au Canada et a nécessité l'attention de nombreux intervenants au sein du bureau de santé publique et de la communauté d'Ottawa. Les infirmières de la santé publique ont proposé aux patientes présentant le risque le plus élevé de contracter le VIH d'être dirigées vers une RNP-RN dans le cadre d'une offre active, et une couverture en médicaments a été fournie aux patients non assurés afin d'assurer un accès égal aux services de PrEP. Les résultats préliminaires ont montré une acceptation de 40% des références à la PrEP chez les patients à haut risque, qui démontre que cette réforme a été efficace à fournir des services à quelques groupes prioritaires, mais plusieurs personnes continuent de refuser la PrEP à cause de leur perception du risque (c’est-à-dire, ils pensent ne pas être à risque pour le VIH).

Research studies are not often considered a form of social justice. However, I put forward an example herein about how I used a grant to provide nursing care to patients who could not otherwise afford the required medication. Specifically, this was the provision of HIV medications in the form of post-exposure prophylaxis (PEP). In doing this, I attempted to use my position as a nurse researcher to address a social justice issue (i.e., the inaccessibility of PEP for those with lower socioeconomic status) and to concurrently alleviate moral distress among the nurses who provide care to these patients. After presenting this project, I reflect on how this helps us reframe nursing scholarship and critical theory. In short, I argue that we need broader defintions of both, so as to better capture what nurses do and to use our positions for social betterment.

Over recent years, in close discussions with others, we have been trying to develop an approach to practice which we call constructive social work (Parton and O'Byrne, 2000). While the elements we discuss will be very familiar to readers of this journal we do feel the idea of constructive social work can offer something which is distinctive and challenging. The central purpose of this paper is two-fold: first to outline what we mean by constructive social work and what we see as some of its central elements; and second to discuss the perspectives associated with constructionism and which we see providing important theoretical frameworks for developing such an approach to practice. Before doing so, however, we outline why we feel it is important to engage in such a task at the present time. Why do we need a constructive approach to social work practice now?

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Amidst fiscal constraint and burgeoning health care demands, an innovative response to sexually transmitted infections was piloted in Quebec (Canada). This response arose out of the relationship of man and machine and resulted in the creation of 'cyborgs' as a communication medium for the dissemination of safer sex messaging. These 'cyborgs' physically carried the prevention message to a traditionally ‘at-risk’ audience, engaged their attention, and elicited an observable response. This paper proposes that at least a small portion of the resources allocated to re-creating old technologies may be diverted to researching and developing original and highly artistic prevention campaigns in Public Health.