Background GetCheckedOnline, launched in 2014 by the BC Centre for Disease Control, is a lower-barrier, digital intervention supporting testing for sexually transmitted and blood-borne infections (STBBI). It allows users to complete anonymous risk assessments, generate lab requisitions, submit specimens at partner labs, receive results online without in-person clinical visits and get connected to treatment as needed. To support ongoing sustainability and scale-up deliberations, we identified essential purposes and mechanisms of the program that should be preserved in varied implementation contexts. Methods We used a three-phase, theory-informed program description approach grounded in the Core Functions and Possible Forms framework, complemented by the Dynamic Sustainability Framework. In Phase 1, we reviewed internal planning documents and published literature to draft GetCheckedOnline’s preliminary core functions – defined as essential program purposes and mechanisms necessary for its impact. In Phase 2, we conducted structured workshops with GetCheckedOnline’s implementation team, public health clinicians, and strategic leads to refine these core functions and co-develop a set of possible delivery forms that could be adapted to diverse contexts, alongside implementation strategies. In Phase 3, we conducted a targeted literature review of digital STBBI testing programs and implementation strategies to strengthen the evidence base for proposed delivery forms and assess their feasibility, equity impact, and fit across varied settings. Results We identified seven core functions of GetCheckedOnline, grouped into three domains: (1) reducing access barriers and supporting equitable entry points to STBBI testing, (2) supporting trust, autonomy, and user-centred engagement, and (3) ensuring continuity of care and responsiveness to emerging population and system needs. For each core function, we mapped current strategies and potential delivery forms that preserve the core functions while supporting sustainable scale-up. Key adaptable forms include integrating mobile and community- or peer-led specimen collection, self-sampling and testing, tiered identity disclosure models (based on user comfort levels), and telehealth-supported treatment linkage. Conclusions Clarifying GetCheckedOnline’s core functions and adaptable delivery forms provides a structured foundation for planning context-sensitive adaptations. This approach supports sustainable, equity-focused digital service delivery and offers a roadmap for integrating digital sexual health services within broader health systems.

IntroductionArtificial intelligence (AI) and algorithmic systems influence health workers’ access, interpretation, and action on clinical and public health information, positioning them as intermediaries between algorithmically mediated outputs and patients, communities, and decision makers. This study examines how AI and algorithmic literacy are conceptualized and measured among health workers through a digital health literacy (DHL) lens.MethodsUsing Arksey and O’Malley’s scoping review framework, we searched Ovid MEDLINE, Ovid Embase, Scopus, IEEE Xplore, ACM Digital Library, Europe PMC, and arXiv for English language sources published between January 2020 and May 2025. Two reviewers screened records and extracted data using a theory informed charting framework grounded in Nutbeam’s model (functional: basic understanding and use; critical: evaluation and ethics; communicative: interacting with AI systems and explaining AI-mediated information). We synthesized findings using descriptive statistics and a narrative synthesis.ResultsTwelve studies published between 2021 and 2025 met inclusion criteria. Evidence was concentrated in health professions education (10/12), primarily among medical (6/12) and nursing students (2/12), with no studies exploring public health practice. Explicit, theory-grounded definitions of AI literacy were uncommon, and links to DHL were only implied. AI literacy was frequently operationalized through self-reported instruments, commonly the Artificial Intelligence Literacy Scale (AILS; 3 studies), Meta Artificial Intelligence Literacy Scale (MAILS; 2 studies) and the Scale for the Assessment of Non-Experts’ AI Literacy (SNAIL), alongside self-developed tools. Only one study explicitly defined and measured algorithmic literacy as a distinct construct; in other studies, algorithmic considerations appeared indirectly through recognizing AI presence in systems or evaluating AI generated content. Across studies, competencies aligned mainly with functional and critical dimensions of DHL, particularly awareness, use, evaluation, and ethics, while communicative literacies were infrequently assessed.DiscussionAI and algorithmic literacy among health workers is underdeveloped, weakly integrated with digital health literacy, and inconsistently measured. Research prioritizes AI literacy using non–health-specific self-report tools and largely overlooks communicative competencies essential to clinical and public health practice. These findings point to the need for clearer conceptual alignment, health-specific measurement, and systems-based approaches to workforce readiness as AI-enabled tools expand across healthcare and public health.

Abstract Background HIV Community-Based Organizations (CBOs) remain underfunded, limiting programming and support, with limited research examining factors influencing women’s engagement with HIV CBOs. Therefore, social-structural factors associated with HIV CBO service use and community participation were investigated among women living with HIV to inform engagement strategies that optimize resource allocation amid funding constraints. Methods Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA) study of 389 cisgender (cis) andtransgender (trans) women living with HIV in Metro Vancouver (September/2014-February/2025). Bivariate/multivariable logistic regressions examined associations between social-structural factors, HIV CBO service use, and community participation. Sample 1 included 270 women (1445 observations;2019–2024) and sample 2 included 227 women (984 observations;2020–2024). Adjusted odds ratios (aORs) were reported with 95% confidence intervals. Missing data were addressed using multiple imputations. Results Sample 1 median age was 48 years (Q1-Q3:40–54) ( n = 270). Overall, 54.1% ( n = 146) were Indigenous, 33.3% ( n = 90) White, and 12.6% ( n = 34) were racialized/women of colour. In multivariable analysis for the outcome of HIV CBO service use, women who were older (aOR:1.04[1.01–1.06](per year)), Indigenous (aOR:1.71[1.07–2.75]), racialized/women of colour (aOR:2.43[1.25–5.60]) (vs. White), reported PTSD (vs. no PTSD) (aOR: 1.62 [1.11–2.37]), and food insecure (vs. food secure) (aOR:1.42 [1.13–1.78]) had higher odds of HIV CBO service use. Among multivariable analysis for the outcome of HIV CBO community participation, older age (aOR:1.06[1.02–1.10](per year)) and graduated high school (vs. did not graduate) (aOR:2.23[1.18–4.23]) had higher odds of HIV CBO community participation, while criminalized substance use (vs. none) had lower odds (aOR:0.56[0.37–0.84]). Discussion Study findings suggest that strategies to support services that engage older, Indigenous, racialized/women of colour, and food insecure populations of women continue to be needed, including sustained funding commitments. Strategies to engage women who are younger, use criminalized substances, and did not graduate high school is recommended.

BACKGROUND:Anal squamous cell carcinoma caused by human papillomavirus disproportionately affects people living with human immunodeficiency virus (HIV; PLWH), particularly gay, bisexual, and other men who have sex with men (GBM). New guidelines recommend screening and treatment of precancerous lesions. We aimed to estimate anal cancer incidence by HIV status, sex, and GBM status in British Columbia, Canada. METHODS:Using administrative health databases, we assessed anal cancer stratified by HIV status, sex, and sexual orientation from 1990 to 2019. A phenotypic algorithm was used to classify GBM status. We evaluated the comparative incidence of anal cancer using Fine and Gray's competing risks subdistribution hazards model. Hazard ratios (HR) were estimated and adjusted for age, healthcare utilization, urbanicity, and Charlson comorbidity index. RESULTS:Among 571 anal cancer diagnoses assessed, the incidence was highest among GBM with HIV [78.09 per 100,000 person-years (PY); 95% confidence interval (CI), 61.24-99.58], followed by heterosexual males with HIV (44.49 per 100,000 PY; 95% CI, 29.56-66.95) and females with HIV (12.05 per 100,000 PY; 95% CI, 4.52-32.11). GBM with HIV experience a 76-fold increased anal cancer risk compared with heterosexual men without HIV (adjusted HR 76.08; 95% CI, 55.14-104.97). CONCLUSIONS:There is an unmet need in anal cancer prevention among PLWH. Screening strategies that are sensitive, specific, acceptable, and cost-effective are necessary. IMPACT:This study provides the first population-based estimates of anal cancer incidence by HIV and GBM status in British Columbia, highlighting disparities and rising trends. These findings support prioritizing targeted screening programs and improving access to care.

Background Digital interventions designed to expand access to sexually transmitted and blood-borne infection (STBBI) testing are promoted to advance equitable health services. Yet many remain pilot projects, limiting their population-level impact. We examined factors influencing the sustainability of GetCheckedOnline, British Columbia’s digital STBBI testing service and described how these factors interact over time during transition beyond piloting and into routine operations. Methods We conducted a qualitative instrumental case study guided by the Dynamic Sustainability Framework. Purposive sampling captured perspectives across intervention, organizational, and system levels. Semi-structured interviews and one focus group were conducted with 28 health systems partners between February and June 2025. Reflexive thematic analysis was used, with attention to temporal shifts across pilot, scale-up, and ongoing operations. Results Four interconnected themes characterized GetCheckedOnline’s sustainability from pilot to scale, demonstrating how early enabling conditions became constraining as post-COVID testing demand increased, laboratory costs rose, and fiscal pressures intensified. First, values-driven urgency acted as both catalyst and constraint: an equity mandate fueled rapid expansion but limited planning for governance, infrastructure, and funding, and early design choices (e.g., manual results entry to support non-nominal testing) created operational complexity. Second, early implementation through flexible governance structures became misaligned at scale, where clearer ownership and accountability mechanisms were required to support system integration. Third, informal relational supports and team resilience were critical to early success, as these enabled progress through trusted partnerships and individual commitment; yet, these placed hidden burdens on staff to manage processes that were not considered as standard operations. Finally, ambiguous system structures which allowed early flexibility became constraints, as reliance on a single laboratory partner able to meet privacy requirements, project-based funding pathways, and limited mechanisms for transitioning pilots into operations impeded full integration despite the service’s demonstrated value. Conclusion GetCheckedOnline’s evolution highlights a patterned inversion during scale up, when early enabling conditions became structural constraints when lacking formal transition mechanisms. For equity-oriented digital services, deliberate pause points and institutionalization of governance, funding, and technical systems are critical for scale. By articulating this inversion dynamic, the study contributes to implementation science and offers insights for jurisdictions scaling similar innovations.

In 2020, Health Canada approved the INSTI human immunodeficiency virus (HIV) self-test. Adoption and distribution of alternative HIV testing interventions, like self-testing, are essential in meeting the United Nations 95-95-95 goals. We explored the acceptability of HIV self-testing among sexual health service providers and Two-Spirit, gay, bisexual, and queer men (2SGBQM). Between 2020 and 2021, peer researchers conducted virtual focus groups (13) and interviews (18) with providers (n = 18) and 2SGBQM (n = 38) across Ontario, Canada, and analysed data using community-based participatory research approach and reflexive thematic analysis. HIV self-testing was highly acceptable among both providers and 2SGBQM. Both groups identified 'increased access to HIV testing' as a benefit. Providers identified 'client empowerment' and 'reduced workload for providers' as other perceived benefits. 2SGBQM highlighted 'convenience' as a key benefit and rationale for self-testing, though some expressed concerns and hesitance due to 'fear of needles/blood' and 'perceptions of lower accuracy and reliability' of self-test results. Providers and 2SGBQM referred to the 'potential for missed connections to care', and 'self-harm' with positive test results as additional concerns for self-testing. Both groups suggested that first-time or inexperienced testers should be tested in-clinic, compared with experienced or regular testers who may benefit from self-testing. Participants expressed that HIV self-testing should be widely available for free, or a modest fee up to $20 CAD. Providers and 2SGBQM both found HIV self-testing highly acceptable, particularly when self-administered by experienced testers. Clinic-based testing remains important, especially for first-time testers and 2SGBQM who have concerns or hesitance regarding self-testing.

Abstract Background Digital services for sexually transmitted and blood borne infection (STBBI) testing may influence demand in publicly funded health systems by enabling low barrier, self-directed access to testing, raising concerns about repeated use and sustainability. We examined longitudinal utilization of GetCheckedOnline, British Columbia’s digital STBBI testing service, to characterize testing trajectories and assess factors associated with higher intensity use. Methods We conducted a retrospective cohort study using GetCheckedOnline program data for users who created an account between April 2020 and November 2022, with 24 months of follow-up. We used group-based trajectory modelling to identify patterns of testing over time among (1) all users and (2) users with at least one test. Multilevel regression models with local health area random intercepts were used to examine associations between higher intensity trajectory membership, individual risk indicators, and geographic clustering. Results Among 34,228 users, 22,542 (65.9%) completed at least one test and 42,451 tests were conducted (median 1; range 0-44). Two trajectories were identified in both analytic samples, with a minority demonstrating sustained higher intensity testing. The top 10% of users accounted for 39.6% of tests. Higher intensity trajectory membership was associated with sexual risk indicators including having multiple partners, condomless sex with multiple partners, and prior STBBI diagnosis. Geographic clustering across local health areas was modest in the null model (ICC 0.042) and attenuated with adjustment. Conclusion GetCheckedOnline utilization reflects a prevention-oriented pattern that appears more consistent with service needs than indiscriminate overuse. A small subset of users with elevated sexual risk account for higher-intensity testing. Findings support risk aligned stewardship including education and differentiated guidance, rather than universal restrictions to reducing testing volumes. Author Summary Digital services are being used to make testing for sexually transmitted and blood borne infections (STBBIs) easier to access. Some health systems decision makers worry that online testing could lead to too much testing and higher costs. We examined how people used GetCheckedOnline, British Columbia’s public online STBBI testing service, over two years. Most people used the service only once or tested occasionally (less than once in six months). A smaller group tested more often. People who tested more often were also more likely to report higher sexual health risk, such as having multiple partners or a recent STBBI diagnosis. This suggests that repeat testing is often done by people who may benefit from testing more often, rather than people testing without need. For health systems, this means it may be more helpful to give clear guidance and education about when to test instead of placing broad limits on access to online testing.

The protective effects of religiosity and spirituality against mental illness and suicidality have been widely established, but the ways these dimensions characterize racialized GBTQ men's suicidality is poorly understood. Drawing on interpretive descriptive methodology and using virtual photovoice methods, individual Zoom interviews were conducted with 32 Canadian-based racialized GBTQ men to explore the connections between their religiosity, spirituality, and suicidality. Using constant comparison analytics, three distinct yet interconnected themes were inductively derived: (a) Differentiating religiosity and spirituality, (b) seeking solace and assurance, and (c) cultivating unwavering faith. In differentiating religiosity and spirituality, participants described reimagining spirituality to waylay the impact of religious trauma while working to reconcile their sexual/gender minority identities and cope with suicidality. In seeking solace and assurance, participants entrusted their emotional pain to a higher power to ease the hopelessness and suicidality that beset them amid the absence of social supports. Lastly, by cultivating unwavering faith, participants summoned spiritual resilience as the foundation for overcoming minority stressors and promoting their mental health in the long term. These findings can guide tailored mental health promotion and suicide prevention interventions to be more responsive to racialized GBTQ men's religious and spiritual needs.

BACKGROUND:Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia's (BC) publicly funded digital STBBI testing service. METHODS:We analysed data from GetCheckedOnline's 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices. RESULTS:Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=-0.263, p=0.006) and use (β=-0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes. CONCLUSIONS:DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.

BACKGROUND:Employing a realist approach, this review aims to describe how direct and indirect socioeconomic elements lead to overdose in people who use opioids. METHODS:We conducted a systematic realist review to understand the underlying structures and processes connecting socioeconomic elements to overdose. Empirical studies published between 2004 and 2019 were identified through six electronic databases (MEDLINE, EMBASE, PyschINFO, CINAHL, Web of Science and Google Scholar), grey literature searches, and manual citation searches. We conducted title, abstract, and full-text screening. We thematically analyzed and synthesized extracted data and performed a quality and relevance appraisal (i.e., assessing the quality of evidence for mechanisms). RESULTS:A total of 55 studies were included in this review. Eight overlapping dimensions with direct and indirect linkages to socioeconomic wellbeing were identified: income and poverty, employment, housing and drug use settings, social networks and norms, criminal justice involvement, gender-based dynamics, acute life events, and stigma. Socioeconomic determinants shaped overdose risk through intermediate outcomes and a range of intersecting material (e.g., deprivation), normative (e.g., fear of criminalization), and bio-psychosocial pathways (e.g., psychological distress or mental illness). A majority of evidence suggested that conditions of socioeconomic adversity trigger drug use as a means to cope with exacerbated mental health concerns or psychological distress (bio-psychosocial pathways), leading to overdose. Supportive evidence for this mechanism was found across all identified socioeconomic dimensions. CONCLUSIONS:Findings point to the need to address the socioeconomic production of overdose risk, with additional emphasis on the pathways and mechanisms linking socioeconomic elements to overdose outcomes.

Internet-based testing services for sexually transmitted and blood-borne infections have increased in prevalence and altered the testing landscape and testing behaviours in many jurisdictions. Our objective was to understand how system partners perceived the possible benefits and drawbacks of adapting and implementing an online testing program like GetCheckedOnline which was already operating in British Columbia, Canada, into a new provincial context where it did not exist. We conducted in-depth interviews and focus groups with sexual healthcare providers, program managers and developers, and other public health professionals with expertise in sexually transmitted infections testing (N = 41) in Ontario, Canada. Our interview questions were part of a larger study focused on improving equitable access to sexually transmitted infections testing. Transcripts were transcribed verbatim and analysed using NVivo software following grounded theory. We created a conceptual figure to chart tensions from participant accounts onto a model of GetCheckedOnline. We describe five key tensions in the accounts of our participants to elucidate perspectives on the possible benefits and barriers/concerns of implementing a digital testing model like GetCheckedOnline in another province: (1) access, (2) privacy, (3) co-ordination/communication, (4) agency, and (5) health system impacts. We map these five tensions across the core elements of the online testing program (i.e., from creating an online account, completing an assessment, and submitting specimens to getting results and engaging in repeat testing). Our analysis elucidates the multiple advantages that online testing modalities may provide for service users as well as substantive barriers and concerns perceived by health system partners, including the potential (unintended) consequences and paradoxes of introducing digital sexually transmitted infections testing.

The interconnections of multiple minority stress and masculinities diversely operate to impact racialized gay, bisexual, transgender, and queer (GBTQ) men's mental health outcomes. However, limited research has explored the connections to racialized GBTQ men's suicidality within Canadian contexts. Guided by interpretive descriptive methodology and using virtual photovoice methods, the current study addresses this gap by drawing on the narratives of 26 Canadian-based racialized GBTQ men. Using constant comparison analytics, three interconnected themes were inductively derived: (i) suppressing isolation and emotional pain, (ii) processing the underbelly of suicidality, and (iii) building mental health strategies. In suppressing isolation and emotional pain, participants spoke to a lack of social support and capacity to fully deal with their suicidality. In this context, distracting themselves from suicidal thoughts was used as a means for staying alive. In processing the underbelly of suicidality, participants reflexively interrogated an array of marginalizing experiences and inequities, with the goal to better understand and waylay their suicidal thoughts. Lastly, in building mental health strategies, participants engaged professional and/or relational supports to sustainably manage and mitigate their suicidality risks in the long term. These findings provide crucial insights for tailoring culturally and gender-responsive mental health promotion and suicide prevention programs that can help racialized GBTQ men manage their suicidality and bolster their mental health resilience in the long term.

Background: Digital sexually transmitted and blood-borne infection (STBBIs) testing services are used to improve testing access, but might replicate existing social inequities. Previous research has shown that the digital STBBI testing service GetCheckedOnline has improved access to testing in British Columbia (BC), Canada. As part of the program's continuous evaluation, we examined awareness and use of the service in 5 urban, suburban, and rural communities where the program has expanded. Objective: This study aimed to determine if social location is associated with differences in awareness and use of the service in 5 communities outside Vancouver, BC. Methods: From July to September 2022, we conducted a cross-sectional survey recruiting (in-person and online) sexually active people aged 16 years or older in 5 urban, suburban, and rural communities where GetCheckedOnline had sample collection sites available at the time. We examined differences in awareness and use by age, gender identity, sexual identity, race/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework. Results: Of the 1658 participants (n=1058, 63.8% in-person and n=600, 36.2% online), 35.3% (586/1658) were aware of GetCheckedOnline and 19.5% (324/1658) had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (>38 years: awareness odds ratio [OR] 0.23, 95% CI 0.17-0.32; use OR 0.19, 95% CI 0.12-0.28; <25 years: awareness OR 0.39, 95% CI 0.28-0.53; use OR 0.28, 95% CI 0.18-0.41). Awareness and use were also lower in the lowest income group compared to the highest (awareness OR 0.39, 95% CI 0.24-0.65; use OR 0.36, 95% CI 0.20-0.65). Awareness and use were higher among genderfluid, genderqueer, and nonbinary participants compared to men (awareness OR 2.27, 95% CI 1.63-3.18; use OR 1.97, 95% CI 1.36-2.84), transgender compared to cisgender participants (awareness OR 2.17, 95% CI 1.54-3.06; use OR 2.15, 95% CI 0.46-3.13), and nonheterosexual compared to heterosexual participants (awareness OR 2.37, 95% CI 1.89-2.97; use OR 2.53, 95% CI 1.91-3.38). People of color had higher awareness and use vs White participants (awareness OR 1.74, 95% CI 1.34-2.26; use OR 2.01, 95% CI 1.48-2.72). Indigenous participants had higher awareness than White participants (OR 1.65, 95% CI 1.19-2.20) but no difference in use. Women had similar awareness but lower use compared to men (OR 0.68, 95% CI 0.50-0.92). Conclusions: GetCheckedOnline is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.

Background We assessed associations between web-design/implementation factors and missed opportunities to provide testing via GetCheckedOnline and assessed if these associations were modified by sociodemographic factors. Methods A cross-sectional survey was conducted in November and December 2022 among clients who indicated needing testing when they created accounts between April and October 2022. Web-design (user interface and experience) and implementation (organization of clinical services around the website) factors were independently modelled against missed opportunities (self-reported inability/unwillingness to test despite needing testing at account creation) using multivariable logistic regression. Effect modification by sociodemographic factors were also conducted. Results Among 572 respondents needing testing at account creation, 183 (32.0%, 95%CI: 28.18-35.99%) experienced missed opportunities. Web-design factors associated with missed opportunities were difficulty using GetCheckedOnline’s website (adjusted odds ratio (aOR) 3.40, 95%CI:1.68-6.87), while implementation factors were difficulty getting to a laboratory (aOR:3.26, 95%CI:1.97-5.41); perceived inadequacy of tests offered through GetCheckedOnline (aOR:1.81, 95%CI:1.11-2.95) and being likely to complete testing if self-sampling was available (aOR:2.12, 95%CI:1.32-3.42). Findings were consistent in sensitivity analyses but concerns about privacy and security of personal information on GetCheckedOnline (aOR:1.93, 95%CI:1.11-3.35) was associated with missed opportunities. Sociodemographic factors modified associations as respondents with annual income < $20,000CAD, not employed full-time, immigrants, men (who did not agree GetCheckedOnline offered all needed tests) and women (who experienced difficulties getting to a laboratory) had higher odds missed opportunities. Conclusions Simplifying web-design, ensuring optimal client education, and including more laboratory locations and self-sampling as options for testing, could reduce missed opportunities and promote equitable access to GetCheckedOnline. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics approval was obtained from the University of British Columbia’s Behavioral Ethics Board (ethics #H18-00437). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable The data underlying this study are part of ongoing program evaluation work at the BC Centre for Disease Control (BCCDC). While these data are not publicly available, they can be provided upon reasonable request, subject to institutional approvals and data sharing policies. Requests for access should be directed to the corresponding author, Ihoghosa Iyamu (i.iyamu{at}alumni.ubc.ca), or the BCCDC’s data governance committee.

Background The digital transformation of health services accelerated during the pandemic. While “digital health” strategies were created, they paid minimal attention to public health services like health promotion, disease surveillance, emergency preparedness, and health protection. Objective This study aimed to inform a digital public health (DPH) strategy at the British Columbia Centre for Disease Control (BCCDC) and explored public health practitioners’ perspectives on challenges and opportunities of integrating digital technologies into public health functions within the organization. Methods In this qualitative description, we conducted 18 focus groups (FGs) between January and June 2023, drawing practitioners from 9 organizational subunits of the BCCDC including population and public health, environmental health, clinical services, vaccine-preventable diseases, communications, knowledge translation, data analytics, and Indigenous health (2 FGs per subunit). Discussions explored practitioners’ application of digital technologies in their public health work, focusing on challenges encountered during implementation (current state FGs) and perceived opportunities (future state FGs). Sessions were audio-recorded, and detailed field notes were taken. Thematic analysis was conducted, comparing perspectives across groups using constant comparative techniques. Results We identified 3 themes. First, “bridging existing inequities—an opportunity and a challenge contingent on public trust” described participants’ excitement about opportunities for DPH to disrupt historical inequities if centered on trust and reconciliation, while recognizing current digital transformation efforts risk exacerbating existing inequities with the digital divide. Second, “a sense of disconnect between “digital” and “public health” functions” described perceptions of DPH as being out of scope of core public health duties, requiring new competencies and navigation of complex organizational policies for which support is suboptimal. Third, “balancing the need for responsive DPH with necessary reactivity” highlighted practitioners’ yearnings for a proactive DPH strategy rather than current issue-based reactive approaches. Participants suggest that a centralized systematic program can help achieve this goal. Conclusions A cohesive, systematic, and proactive organizational strategy for DPH is critical to enable equity-focused digital transformation. Such a strategy can bridge perceived disconnects between digital and public health functions through organizational supports like competency development and streamlined policies that can better support public health practitioners to integrate digital technologies into their work.

ABSTRACT:GetCheckedOnline.com is a digital sexually transmitted and blood-borne infection testing service provided in British Columbia, Canada. Using a micro-costing approach, we calculated the costs during the planning, development, and implementation phases of GetCheckedOnline.com . As more sexually transmitted and blood-borne infection tests were performed, the cost per test decreased, demonstrating economies of scale.

BACKGROUND OR CONTEXT:Studies reporting the use of digital tools to promote the prevention and treatment of sexually transmitted and blood borne infections (STBBIs) have proliferated in recent years. Previous reviews highlight variability in the input sought from users in tool development, and its contribution to impact. OBJECTIVE:This scoping review sought to describe approaches to seeking and utilising user input, with the goal of providing guidance for developers. SEARCH STRATEGY:Searches were conducted in MEDLINE, PsycInfo, and the Social Science Citation Index and results screened by two reviewers. The reference lists of included studies and review papers were also checked. INCLUSION CRITERIA:Peer reviewed qualitative and mixed methods studies seeking user input on digital tools promoting the prevention and treatment of STBBIs, from prototyping onwards, published from after 2014 in English, were included. DATA EXTRACTION AND SYNTHESIS:Reported methods and findings were charted in Excel and synthesised using content analysis to provide an overview of methods and domains of user input and utilisation of this input. MAIN RESULTS:A total of 1838 unique titles and abstracts and the full text of 50 publications were screened. Data was charted from 37 eligible studies reporting findings from 34 projects developing digital health tools, including smartphone/tablet applications, websites/web-based applications, chatbots, interactive automated SMS, and purpose-built tools within dating and social media applications. Studies reported on tools developed for use by diverse target populations. The most common domain of input reported was usability (n = 31), while others-namely, satisfaction (n = 27), acceptability (n = 25), formative (n = 24), impact (n = 22), accessibility (n = 17), and engagement (n = 11)-were reported less consistently. User views were sought using qualitative methods such as interviews, focus groups and open-ended survey questions, more often in combination with quantitative measures such as participant-rated measures and engagement analytics. User suggestions for changes were reported in relation to three in four projects studied but incorporation of changes in less than half of projects. DISCUSSION AND CONCLUSIONS:This review demonstrates considerable homogeneity in reported user input in the development of digital health tools. Input from users as co-designers may improve the impact of tools on their intended outcomes. PATIENT AND PUBLIC CONTRIBUTION:This literature review brought together a group of researchers who have sought user input in the development of digital sexual health tools, but, due to resource limitations, did not involve potential users themselves, who are of diverse and disparate groups.