GetaKit and the prevention cascade: understanding the impact of HIV self-testing on linkage to prevention services in Ottawa, Canada


BACKGROUND: The GetaKit HIV self-testing initiative launched in July, 2020. The initiative primarily sought to assess the feasibility, accessibility, and impact of a mail-out HIV self-testing program in Ottawa, Canada. The secondary objectives of the initiative were to assess the impact of the program on linkages to confirmatory testing and care, and prevention services (PrEP). GetaKit was led by a team of nurses at University of Ottawa and Ottawa Public Health, in collaboration with staff from Ottawa ASOs and the OHTN.
DESCRIPTION: As of July 20, 2020, eligible participants ('¥18 years old, HIV-negative, not on PrEP, not in a HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via to order kits. Testing kits were mailed to clients' homes in Ottawa. The initiative utilized a status-neutral approach, providing follow-up for all clients to connect them with either confirmatory bloodwork or HIV prevention (PrEP). Participants who reported a negative or non-reactive test result were contacted by an ASO staff member or member of the Ottawa Public Health team for follow-up and linkage to PrEP and other services.
LESSONS LEARNED: As of February 2021, 388 eligible participants completed baseline surveys and 259 ordered a test Approximately 43% (n=167) of eligible participants reported negative test results. Of those 167 participants, approximately 69% (n=115) belonged to HIV priority groups and were offered PrEP. Participants had an optional 6-month window to contact the Ottawa Public Health team to initiate PrEP after follow-up. Immediate PrEP uptake was approximately 20% (n=23). Other STIs, as well as the need for HAV, HBV, and HPV vaccines, were identified among the participants who initiated PrEP.
CONCLUSIONS: Our findings indicate that HIV self-testing is an effective gateway for HIV and other sexually transmissible and blood-borne infection prevention services; including PrEP access among persons who otherwise wouldn't have considered it, vaccination, and STI identification and treatment of asymptomatic infections. HIV self-testing is therefore a promising tool in increasing linkage to the prevention cascade.