Understanding contextual factors to effectively and equitably scale up GetCheckedOnline to diverse populations and geographic settings

Digital health services are thought to be cost-effective and improve access particularly in rural areas, despite limited evidence and challenges to their implementation. We need to examine the "rhetoric and reality" of these services, and understand what external factors influence their success or failure. GetCheckedOnline (GCO) is an effective program developed by the BC Centre for Disease Control to reduce barriers in accessing testing for sexually transmitted infections and blood borne infections (STBBI). Research from the Vancouver pilot phase of GCO has found the service to be acceptable and effective in reaching people with barriers to accessing testing. Our initial analysis of GCO's scale-up to other urban, suburban and rural communities in two regional health authorities (RHA) in BC has found differences from Vancouver and between expansion sites (e.g., in the proportions of first-time testers). Further scale-up in BC is planned to other RHA, and eventually to other parts of Canada. However, further adaptation of GCO may be needed to reach other populations facing barriers to STBBI testing. Our team's overall goal is produce research which leads to the best implementation and maximum effectiveness of GCO for multiple populations affected by STBBI, and that informs further scale-up in BC and potentially in other parts of Canada. We do this in order to reduce barriers to accessing testing, leading to earlier diagnosis and linkage to care for STBBI in Canada. Our research approach uses an implementation science framework to: (1) understand what works, for whom, during scale-up; (2) adapt the intervention for better impact in minority language communities, men sex workers, and people who inject drugs; (3) assess the feasibility of implementation in a different health care system (Toronto); and (4) describe external factors influencing GCO implementation and whether access is improved equitably across populations who use it.