GetCheckedOnline Ontario? Exploring Digital STI Testing in a Context of Political-Economic Complexity.

Background
GetCheckedOnline (GCO) is an internet-based sexually transmitted and blood-borne infections (STBBI) testing program available in select regions in British Columbia (BC). GCO has been shown acceptable to a range of patient populations and scalable to different jurisdictions within BC. We are investigating the potential implementation of online STBBI testing in Ontario, focusing on meeting the testing needs of gay, bi, queer, and other men who have sex with men.

Methods
We used institutional ethnography (IE) to investigate how provincial context could shape the introduction of GCO, or a similar online testing model, into Ontario. Data were collected between 06/2019-12/2019. Sources to date included participant interviews (n=20), observations (e.g., community forums on testing), and an analysis of documents pertinent to STBBI testing in Ontario (e.g., Ontario Health Protection and Promotion Act). Participants had expertise in STBBI testing and sexual health services (e.g., public health physicians, nurses, program managers). Data were coded and analyzed iteratively using IE work process mapping.

Results
Local legislation and political factors were salient when exploring online testing in a new provincial context. The Laboratory & Specimen Collection Centre Licensing Act was identified as the main piece of legislation limiting the opportunity for online STBBI testing in Ontario. Participants also discussed how changes in provincial political leadership and the current political-economic landscape of austerity shape health service innovation and expansion. Participants anticipated that if “evidence” of “best practice” together with health economics analyses indicate GCO’s potential cost savings, a “business case” strategy could be leveraged to gain the support of decision makers.

Conclusions
Leadership, legislation, and logics of austerity direct the activities of health service developers and the gathering of “evidence” deemed valuable by decision makers. Our analysis reveals the everyday actualities of health service innovation and expansion in the context of political-economic complexity.