JMIR Publications

ABSTRACT

Background:

With the need to expedite the detection of multiple sexually transmitted blood-borne infections (STBBIs), there is an increased demand for digital solutions to improve the efficiency of point-of-care (POC) testing conduct in outreach community settings. In parallel, multiplexed screening is being offered to at-risk populations by front-line healthcare professionals.

Objective:

With this in mind, we evaluated AideSmart! (for health aides /healthcare workers), an integrated app/platform solution that enables multiplexed STBBI screening at the point of care for feasibility, preference, accuracy, and impact. AideSmart! provided trained healthcare workers to conduct rapid multiplexed tests, improving data documentation, improving STBBI pre/post-test counseling, maintaining quality assurance of testing, facilitating linkages to care, and enhancing provider-patient communication and patient engagement throughout the STBBI screening and linkage process.

Methods:

In a cross-sectional study conducted during the COVID-19 pandemic, we recruited at-risk populations in Canada from community-based organizations in Montreal and Saint John with unknown knowledge of their human immunodeficiency virus (HIV), hepatitis C virus (HCV), and syphilis serostatus. Following pre-test counseling with AideSmart!, we performed multiplexed testing with rapid tests, and initiated confirmatory lab-based testing and linkages to care. We tested participants simultaneously for HIV, HCV, and syphilis, with two rapid investigational Multiplexed tests (Chembio for HIV/Syphilis, MedMira for HIV/HCV/Syphilis).

Results:

Of 401 participants, all (100%) accepted the AideSmart! Multiplexed strategy: 59% preferred multiplexed rapid over lab testing, and 57% preferred receiving same-day test results. Feasibility of strategy (completion of testing and linkages to care) was 76%. Rapid test results were yielded in 15 minutes (vs. lab tests at 4-24 days). Twenty-nine new infections (27 HCV, 1 syphilis, 1 HIV) were detected and treated in 3 visits (within a week). Using lab-based testing as reference standard tests, multiplexed rapid tests’ specificity exceeded 98% (98·7-100·0%) for the pathogens and devices. An electronic reader enhanced Chembio’s sensitivity: HIV 100·0% (95% CI: 79·4-100·0%), syphilis 86·8% (95% CI: 71·9-95·6%); MedMira’s yielded sensitivities of 100·0% (95% CI: 78·2-100·0%) for HIV, 90·3% (95% CI: 80·1-96·4%) for HCV but 57·9% (95% CI: 40·8-73.7%) for syphilis. Healthcare professionals and providers provided positive feedback on the strategy and emphasized the importance of knowing one’s negative or positive serostatus especially during a pandemic.

Conclusions:

AideSmart!, an app-integrated digital multiplexed rapid screening strategy for healthcare workers provided training that facilitated STBBI detection, counseling, testing, and rapid linkages to clinics, while satisfying end user preferences for rapid multiplexed testing. Readers enhanced the diagnostic performance of multiplexed biomarker tests. The study generated valuable data supporting digital Multiplexed strategies in digitally-enabled settings for at-risk populations, nationally and worldwide.