NWT RESEARCH DATABASE

Regions: Inuvialuit Settlement Region, Sahtu Settlement Area, Dehcho Region, North Slave Region, South Slave Region

Tags: health care, health care evaluation, HIV/AIDS, implementation science, Harm Reduction

Objective(s): To implement and scale up to 100 interactive dispensing systems (IDS) in partnership with community-based agencies across Canada to provide low barrier access to HIV self-test kits, harm reduction and sexual health materials to reach those undiagnosed with HIV and provide access to those at high risk of HIV testing to know their status, and to provide support for linkages to care.

Project Description: This licence has been issued for the scientific research application No. 5928. Overall aim: This three-year implementation science program aims to implement and scale up to 100 interactive dispensing systems (IDS) in partnership with community-based agencies across Canada to provide low barrier access to HIV self-test kits, harm reduction and sexual health materials to reach those who are undiagnosed with HIV and provide access to those at high risk of HIV testing to know their status, and provide support for linkages to care. Research question: Does access to low barrier technologies, such as Our Healthbox (IDS), improve people’s access to and engagement with HIV self-test kits, harm reduction and other wellness supplies? Does this lead to an increase in HIV diagnoses, decrease in harms related to drug use, and improved linkage to care, treatment and prevention services? Specifically, who is being reached, how are they using the machine for their health needs and its impact on health and wellness, stigma around access to HIV testing and harm reduction and connections to care. The team will evaluate if the program can: (1) reach people who are undiagnosed with HIV who have complex health, social and substance use to know their status and link to the care they need; (2) reach a significant proportion of first-time testers for HIV and subsequently link them to prevention care; and (3) provide access to harm reduction supplies to reduce harms for people who have systemic and structural barriers to accessing testing, prevention, care and treatment. Our Healthbox is designed as an implementation science research program. The team is partnering with community-based organizations (CBOs) and health agencies to implement the program in phases to scale up to 100 Healthboxes in communities across Canada over 3 years. The team is attempting to understand the implementation and scaling of Our Healthbox, as an access tool for HIV self-test kits, harm reduction supplies and other items to help address health inequities in Canada. Our Healthbox is guided by the RE-AIM implementation science framework (which we used to plan and evaluate this healthcare intervention) and focused on the 5 key RE-AIM outcomes: Reach, Effectiveness, Adoption, Implementation, and Maintenance (please see attached protocol for more details on how each outcome will be evaluated). Interactive dispensing systems (IDS) will be placed in various locations across Canada and will provide access to HIV self-test kits (provided by REACH Nexus), harm reduction supplies (from existing supply chains provided by government / local community based organizations; e.g. sterile needles for safer injection, naloxone kits), other determined needs (COVID-19 test kits, seasonal or culturally specific supplies like smudge kits). Each community and host agency will choose which items to stock based on their population needs. These include things like self-test kits, harm reduction supplies, sexual health and other wellness items we often take for granted. Individuals will be able to access the HIV self-test kits and harm reduction and other materials directly from the IDS unit (24/7/365, or during specified time periods according to specifications from sponsoring community-based agencies). The primary population are people with undiagnosed HIV infection and key/priority populations at high-risk of HIV infection and other STBBIs (sexually transmitted and blood-borne illnesses) including persons who use substances (including people who inject drugs), gay,bisexual and other men who have sex with men (gbMSM), black, Indigenous, and other people of color (BIPOC), people engaged with the sex-trade (sex workers) and persons who have never been tested for HIV. People join the program by self-referring at their local Healthbox machine. Participants are: Living in Canada, at least 16 years of age (18 years in Quebec), and Read and understand English or French. Our Healthbox is helpful, accessible and without judgment. Persons use the interactive interface to join the program, create a simple and unique login (e.g. year-colour-avatar), and complete a one-time demographic survey. Participants can dispense free supplies (sign-in/sign-up is needed, except for life-saving naloxone)*, access educational materials and the healthcare services directory to connect to care (no sign-in required for these resources). For return visits, participants simply login to dispense items they need. Along the way, a few questions are asked about items accessed, their experience and connections to care. Information collected is anonymous and helps to inform program funding, evaluation and ultimately, improve how we connect people to the care they need. The team will also conduct interviews with staff from the host sites to better understand the implementation process. It plans these as virtual, one-on-one or focus group interviews and participation will be voluntary. Data gathered from these interviews will be coded, not linked to personal information and will be grouped or thematically analyzed. These data collection tools were designed with input from community agencies and people with lived experience (living with HIV, people who use substances and those experiencing homelessness). Evaluation will be done using the anonymous, program data including: 1. Participant surveys - anonymous, optional at sign-up (including demographics), dispensing items, return use (1 week) and follow-up (1, 3, 6 months) a. Participants will answer demographic questions about who they are (e.g. gender, sexuality, ethnicity, employment status, overall health etc.) b. Pre-Dispensing questions on why they are accessing the HIV self-test and if they have ever tested for HIV before and who they are accessing harm reduction supplies for and how often they access harm reduction supplies, and why they are accessing the Naloxone kit, how often they access it, and if they have ever had any difficulties accessing it. c. Returning User Follow-up Questions (Starting at 1-week), participants will be asked 4 questions on their satisfaction with Our Healthbox. d. Returning User Follow-up Questions (Starting at 1,3,6, months), participants will be asked questions regarding linkage to care (prevention and confirmatory) 2. Machine dispensing data (e.g. item counts, number, time and duration of machine use/visits) 3. Host organization interviews - coded, de-identified. The team is collaborating directly with the Office of the Chief Public Health Officer (OCPHO) in the Northwest Territories to implement this program and to develop the knowledge mobilization plan. The OCPHO is supportive and has been working with communities where these Healthboxes are needed and are in the process of identifying the locations/host sites for the machines. As part of the implementation agreement, the team will share the program data with the OCPHO and with sites as needed upon reasonable request as the data stewards. Data collected will be near real-time and sites will have ongoing access to the dispensing data through the IDS data portal that we have developed and summary data from the participant surveys upon request. Information can be regional or by site depending on reporting and community needs. The team will also share summarized program findings at conferences and through publications in journals and on our website (www.ourhealthbox.ca) periodically. The program data may also be stored at T-CAIREM at the University of Toronto for public access with permissions. Throughout the 3-year project, in addition to the resources provided by the OCPHO, communities have the ability to tailor additional Healthbox contents to meet the specific priorities and needs their community. Items stocked can change over time based on the use and needs of the community. The OCPHO is also actively educating health care providers in the region around harm reduction, HIV self-testing and connecting persons to the care they may need. Community education around harm reduction, sexual health and care is also being priorotized within the region. Promoting cultural safety is a priority to REACH Nexus as well as the NWT Department of Health and Social Services Partners. At its core, the goal of the Healthbox initiative embodies cultural safety as it aims to provide low-barrier access to self-testing kits, essential harm reduction and sexual health supplies for free to residents, and to provide health information, and a support services directory for people to find the health care they need – in their community. Cultural safety practices were maintained during the planning and project initiation phase through one-on-one consultations between the OCPHO and local Indigenous governments (IGs) in the select host sites. This included a Q&A session with REACH Nexus lead researchers providing an opportunity for all local stakeholders to raise specific questions and concerns. These open communication pathways will be maintained for the duration of the project between the OCPHO and the community stakeholders. The fieldwork for this study will be conducted from: September 10 - December 31, 2024