From Pilot to Scale: Understanding and Informing Sustainability and Health System Fit for Digital STBBI Testing Interventions Using a Decade of Implementation Data 

Short Synopsis: Digital interventions facilitating access to testing for STBBIs have expanded rapidly, yet there is limited evidence to guide how successful innovations can be sustained and integrated in the broader health systems as they move beyond pilot implementation. This presentation shares findings from a multi-methods embedded health systems research study examining the long-term sustainability of GetCheckedOnline, British Columbia’s digital STBBI testing service. Drawing on implementation science frameworks, qualitative system analysis, and longitudinal analyses of testing patterns, this work identifies how sustainability challenges emerge as digital services scale within real world health systems. The research highlights recurring tensions between equity oriented service design, health system capacity, and accountability for program growth. New evidence on testing trajectories shows that sustained high frequency testing is strongly associated with ongoing sexual risk and other individual factors, rather than indiscriminate use alone. This presentation shows how findings have provided applied insights for policy makers, clinicians, and community partners seeking to adapt, integrate, and sustain digital STBBI testing services beyond early pilot success.