Abstract
<title>Abstract</title> <p> <bold>Background</bold> Sexually transmitted and blood-borne infections (STBBI) pose significant public health challenges globally. Pharmacist-led testing programs may overcome barriers and improve access and equity. The APPROACH 2.0 study aimed to assess implementation factors associated with developing and implementing a pharmacist-led testing program for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and syphilis infections in community pharmacies across three Canadian provinces. <bold>Methods</bold> We utilized a mixed-method exploratory cross-sectional design, offering participants a choice of point-of-care (POC) testing for HIV and HCV and/or dried blood spot (DBS) testing for HIV, HCV, and syphilis available at community pharmacies and outreach events. Pharmacists completed a comprehensive training program prior to recruitment. We used the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework to guide evaluation, with focus on reach, effectiveness and implementation. <bold>Results</bold> Between December 2022 and April 2024, 399 participants aged 18-75 years were tested. The study reached participants who had not been tested previously (35% HIV, 43% HCV, and 62% syphilis) despite many reporting risk behaviours supporting STBBI testing. In total, 1424 tests were performed including 598 HIV tests (386 participants), 555 HCV tests (349 participants), and 271 syphilis tests (271 participants). While some participants reported no preference for type of testing (36%), 79% reported the importance of having test results immediately, some indicating that they would not go elsewhere (15%) or were unsure if they would go elsewhere (32%) if pharmacist testing was not available that day. Twenty-five participants received reactive results with four active HCV infections and two active syphilis infections confirmed. Overall, protocols were delivered as intended and length of testing visit was feasible. <bold>Conclusions</bold> Our findings demonstrate the potential of a pharmacist-led HIV, HCV, and syphilis testing service to reach untested populations. Implementing pharmacist-led testing tailored to individuals’ varied needs and preferences may reduce barriers, allow for earlier detection and linkage to care, and contribute to improved public health outcomes. Future research should explore implementation factors to optimize reach to priority populations, integration into existing pharmacy workflow, provincial public health systems and community, and maintenance to support scale and sustainability. <bold>Trial Registration</bold> This study was registered with ClinicalTrials.gov (NCT05534633). </p>