Point-of-Care Testing for Sexually Transmitted and Blood‐Borne Infections: A Canadian Realist Review
Canada has endorsed global targets to eliminate sexually transmitted and blood-borne infections (STBBI) as public health threats by 2030. Despite these goals, STBBI – including HIV, hepatitis B (HBV) and hepatitis C (HCV), human papilloma virus (HPV), Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis, and Trichomonas vaginalis – continue to be important public health concerns. Notably, reported rates of STBBI have been on the rise for the last decade in Canada and there is a resurgence of congenital syphilis. Furthermore, a significant number of people remain undiagnosed or unaware of their HIV and/or HCV status, as stigma prevents people from seeking medical care and healthcare practitioners may be reluctant to offer STBBI testing routinely.
As testing is the gateway to the continuum of prevention, care and treatment, elimination can only be achieved by reaching the undiagnosed through the implementation of new and innovative strategies that ensure timely and equitable access to quality care, diagnosis and treatment. Many accurate and reliable STBBI POCTs are licensed and used globally, but in Canada only two rapid tests are licensed currently and their availability varies across the country.
This realist review aims to contribute to a greater understanding of the usefulness of STBBI POCT in Canada by highlighting what we found in the literature in terms of the enablers and barriers to implementing STBBI point of care testing. It includes a summary of the evidence regarding feasibility, cost effectiveness, detection of positive cases and early diagnosis, linkage to care, user preference, acceptability and uptake (including traditional serology versus POCT; single versus multiplex tests).
The review first focusses on populations most affected by STBBI and then outlines key considerations when implementing POCT in different settings, from urban to rural, hospital to non‐conventional testing sites. Each section considers the evidence in relation to Canada’s complex health care and public health systems, its unique geography and many jurisdictions. Lastly, the review summarizes important strengths and weaknesses of POCT in comparison to traditional serology testing.
Point of care testing for HIV, HCV and syphilis has been shown to be feasible and effective, and generally has high acceptance among populations most affect by STBBI. However, the context for testing and treatment follow‐up is important. There are also still barriers for specific populations, such as people with unstable housing, people who use drugs and people who face racism and other forms of stigma. Expanding the range of providers who can offer POCT (e.g., peers, counsellors) may increase uptake. Information and education for those testing and those being tested ‐‐ including to improve counselling and to address stigma ‐‐ are important components to consider for new POCT programs.
The review concludes with areas for further exploration, including potential research to address knowledge gaps. Careful planning of STBBI POCT is critical to success; the entire process from testing and linkage to care, through to treatment completion must be considered when planning an effective testing campaign or programme. Implementation based on meaningful community and stakeholder engagement, careful examination of available evidence, and new research will bring Canada a step closer to meeting the global targets aimed at eliminating STBBI as a public health threat by 2030.