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.

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.

BackgroundThere is rising detection of unregulated stimulants (e.g. cocaine and methamphetamine) in toxicology results among people who died of unregulated drug poisoning. Nevertheless, little research describes the population-level trends of incident (new) stimulant use disorder (StUD) diagnoses. This study reports on trends of incident StUD diagnoses pre- and post-Covid-19 public health emergency in British Columbia (BC), Canada.MethodsInterrupted time series analyses were conducted with BC’s COVID-19 public health emergency declaration on March 16, 2020 as the interruption point. Descriptive statistics on demographic and health service contact were conducted for the population diagnosed before (January 1, 2013 - March 16, 2020) and after (March 17, 2020 - December 31, 2024) the COVID-19 pandemic emergency declaration. Seasonal autoregressive integrated moving average (sARIMA) models were used to .estimate changes to incident StuD diagnoses rates before and after the COVID-19 pandemic declaration.Results38, 217 people were identified with incident StUD diagnoses between January 1, 2013 and March 31, 2024. The average diagnosis rate of incident StUD was 5.18 per 100, 000 in the pre-pandemic period and increased by 19.9% to 6.21 per 100, 000 in the post-pandemic period. The estimated increase in slope (ramp) of incident StUD was 0.0315 cases per 100, 000 population per month (95% CI: -0.00182, 0.06482).ConclusionsWe identified a rate of increase in incident StUD diagnoses since the COVID-19 pandemic declaration in BC that was not statistically significant. Our study highlights the need for more comprehensive linked data -including, administrative health data, surveys, and other services/program data (e.g., community services, private sector) to better disentangle StUD incidence and prevalence to inform services to meet the needs of people with StUD. Stimulant use, Stimulant use disorder, pandemic, Covid-19, methamphetamines, cocaine, interrupted time series.

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.

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.

People who experience criminalization, such as those who use drugs, are incarcerated, and are affected by homelessness, have a high prevalence of HIV and/or hepatitis C virus (HCV) infection and low treatment uptake in British Columbia. Barriers to care include unreliable means of maintaining contact with healthcare providers. To reduce these barriers, the Test, Link, Call (TLC) Project provides cell phones and peer health mentors to support access to HIV and/or HCV care. This study aims to determine the outcomes and acceptability of TLC and its impact on care engagement. A mixed-methods evaluation was conducted over the first 29 months (October 2021–March 2024) of the TLC Project. Data were collected concurrently in two rounds: the first after one year and the second two years after launch. Qualitative data were collected using semi-structured interviews conducted with healthcare providers (n = 8), peer health mentors (n = 6), and program participants (n = 20). Quantitative data, including demographic and clinical information, were gathered through program records and cross-sectional clinical chart reviews. Factors associated with HCV treatment uptake were assessed among HCV RNA positive participants (n = 245) using multivariate logistic regression. Data from both rounds were integrated for comprehensive analysis. 273 participants were enrolled in HCV care, and 26 in HIV care. Interviewees found TLC highly acceptable and effective. Positive outcomes included increased access to health and social services, connection to loved ones, independence, and safety. Challenges included phone theft and digital literacy issues. Overall, 57

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.

Background: National hepatitis C virus (HCV) elimination efforts are contingent on the provision of care in prisons. This study aimed to assess HCV care practices in Canada's provincial/territorial prisons in 2024, comparing trends from 2020 to 2024.Methods: From June 14 to October 31, 2024, one representative per prison health care team (excluding Nunavut) completed a web-based survey. The outcomes of interest were HCV screening, access to direct-acting antivirals (DAAs), linkage to care following release, and access to opioid agonist therapies (OAT) and prison-based needle and syringe programs (PNSPs). Non-nominal data were aggregated by province, and descriptive statistical analyses were used to report outcomes.Results: The survey was completed by 88/94 (94%) prisons. In total, 85 prisons offered HCV screening. On-demand (15/85; 18%), risk-based (1/85; 1%), and opt-in (9/85; 11%) screening declined since 2020, while opt-out (15/85; 18%) and combination (45/85; 53%) screening increased. Reflex RNA testing occurred in over half (46/85; 54%) of prisons. DAAs were offered in 74/88 (84%) prisons, and 65/74 (88%) provided the remainder of DAAs at release to facilitate treatment completion. In 2024, the majority (78/88; 89%) of prisons facilitated continuity of care following release. OAT was available in most prisons (83/88; 94%), and in 2024, more prisons offered OAT for people who had never been on OAT (73/83; 88%). Not a single prison had implemented PNSPs.Conclusions: While there were improvements in prison-based HCV care from 2020 to 2024, HCV care was still not equivalent to that in the community in 2024, jeopardizing HCV elimination efforts both in prisons and in surrounding communities.

The rise in heterosexual syphilis transmission across North America has drawn attention to the risk of a comparable trend for HIV. After an increase in HIV diagnoses among individuals reporting only heterosexual contact in Washington state we coordinated with jurisdictions across the US-Canada border to analyze regional trends. In 2023, presumed heterosexual HIV diagnoses in the international Pacific Northwest increased by 70% vs. 2018-2023 with increases of 82% in Oregon and Washington.