GetaKit, a self-testing kit for HIV


Volume 47 No. 10, October 2021: Influenza Vaccine

Observational Study

HIV self-testing in Ottawa, Canada used by persons at risk for HIV: The GetaKit study

Patrick O'Byrne1, Alexandra Musten2, Amanda Vandyk1, Nikki Ho1, Lauren Orser1, Marlene Haines1, Vickie Paulin3


1 School of Nursing, University of Ottawa, Ottawa, ON

2 Ontario HIV Treatment Network, Toronto, ON

3 Ottawa Public Health, Ottawa, ON


Suggested citation

O'Byrne P, Musten A, Vandyk A, Ho N, Orser L, Haines M, Paulin V. HIV self-testing in Ottawa, Canada used by persons at risk for HIV: The GetaKit study. Can Commun Dis Rep 2021;47(10):435–41.

Keywords: HIV, self-test, Ottawa, Canada, priority group, GetaKit


Background: The Public Health Agency of Canada estimates that about 87% of persons living with human immunodeficiency virus (HIV) in Canada have been diagnosed, which is well below the Joint United Nations Programme on HIV/AIDS target to have 95% of HIV-positive persons diagnosed. Research has shown that HIV self-testing may help increase such diagnoses, especially among the populations who are most affected by HIV. The objective of the study was to determine the uptake and diagnosis outcomes associated with free HIV self-testing.

Methods: We developed the first online mailout free HIV self-testing program in Canada and implemented it in Ottawa. This project ran through the website, We intended to recruit 150–400 participants over a 6–12-month period, estimating that this number would yield between 0–1 positive test results (expected positivity rate of 0.08%).

Results: Between July 20, 2020 and April 1, 2021, 1,268 people accessed the GetaKit website and verified their eligibility. In total, 600 persons were eligible and 405 ordered an HIV kit. Of those who ordered a kit, 399 completed a baseline survey. Overall, 71% of these participants were members of HIV priority groups. For test results, 228 persons reported test results, with one being positive, for a positivity rate of 0.24% overall and 0.44% of reported results. These rates exceed that normally observed in Ottawa.

Conclusion: Self-testing of HIV can be effectively delivered through a website. Such an intervention will also be used by persons with undiagnosed infections and appears to do so at a rate higher than that observed by other means of testing. Self-testing of HIV may therefore help Canada achieve the United Nations 95-95-95 targets.


The Joint United Nations Programme on HIV/AIDS 95-95-95 targets aim to have 95% of persons living with human immunodeficiency virus (HIV) diagnosed, 95% of those diagnosed engaged in care and 95% of those in care achieving and maintaining a suppressed HIV viral load by 2030Footnote 1. However, the Public Health Agency of CanadaFootnote 2 estimates that in 2018 only 87% of HIV-positive persons in Canada were diagnosed. Moreover, PHAC data highlight that in addition to approximately 13% of persons remaining undiagnosed, HIV continues to unequally affect the same priority groups: gay, bisexual and other men who have sex with men (gbMSM); persons who are transgender; individuals of African, Caribbean or Black ethnicities; members of Indigenous communities; and persons who use drugsFootnote 3Footnote 4. One factor that likely contributes to this ongoing transmission and to why persons remain unaware of their HIV-positive status is persistent barriers to current methods of HIV testing, including at the individual level (fear of results, concerns about confidentiality, etc.), at the healthcare provider level (stigma, reluctance to test, etc.), and at the institutional/policy level (criminalization of behaviour, limited resources, etc.)Footnote 5.

Because HIV self-testing, compared to peer and clinic-based testing, often corresponds to increased testing, diagnosis and reported user satisfaction among members of HIV priority groupsFootnote 6Footnote 7Footnote 8Footnote 9, we studied the outcomes associated with free at-home HIV self-testing in Ottawa. To accomplish this, we launched GetaKit (, which was the first online mailout program in Canada through which individuals could order an INSTI® HIV self-test and have it delivered to their home or other designated pick-up location. While other studies have observed patients completing self-testing in controlled clinical settings, in implementing GetaKit, our goals were to: 1) evaluate HIV self-testing in real-world settings, 2) facilitate HIV testing, 3) identify persons with undiagnosed HIV infection and 4) link persons to care or prevention services depending on their HIV test result. While we have detailed GetaKit implementation elsewhere, herein we report findings from July 20, 2020 to April 1, 2021 and describe our participants, including details about the number who belonged to a priority group or who identified as women; we also report on the correlates of first-time testers and persons who reported their results.



GetaKit is an open-cohort prospective observational study with three phases. Phase 1 piloted free at-home HIV self-tests in Ottawa. Because test positivity for HIV was 0.1% in Ontario and 0.08% in Ottawa (unpublished data—available upon request), a 6–12-month period was deemed sufficient to enroll 150–400 adults who could test up to three times each; we expected 0–1 positive result from this sample. Phase 2 involved self-test delivery in additional sites in Ontario. Phase 3 involved the addition of full sexually transmitted infection testing. This article reports on Phase 1.

Data collection

To be eligible, persons had to be HIV-negative or of unknown HIV-status, 18 years of age or older, live in or around Ottawa and have a cellular phone. Exclusion criteria included being on pre-exposure prophylaxis (PrEP), being in an HIV vaccine trial and having a diagnosed bleeding disorder.

For recruitment, we created and engaged in public awareness through posters in public places and healthcare centres and via social media. We worked with local acquired immunodeficiency syndrome service organizations to promote to priority groups.

Data collection occurred via Stepwise, potential participants had to first complete an anonymous eligibility screening test, for which all questions were obligatory. Ineligible persons were referred to other resources for testing and support. Eligible persons could register, which involved providing a name, date of birth and cellular phone number (for two-factor authentication). Once registered, participants were asked to complete a survey, which collected information about country of birth, ethnicity, sex, gender, sexual orientation, sex and drug use practices and HIV testing history; "prefer not to answer" was an option in the survey. Once completed, participants could order an HIV self-test, which would be delivered in 1–3 business days. The self-test and shipping were free. We asked, but did not require, participants to report their HIV self-test results via

The Ontario HIV Treatment Network funded GetaKit and the University of Ottawa Research Ethics Board approved the project (H-12-20-6450).

Data analysis

Data were extracted from into an Excel file. Participant characteristics were reported for the total sample using frequencies and percentages. We stratified by gender, described the participants who identified as women using frequencies and percentages, and used bivariate X2 to determine which characteristics differed significantly between groups. For outcomes of interest, we sought to understand which participants: 1) had previously completed HIV testing, 2) reported their HIV self-test results and 3) completed the HIV self-test appropriately (i.e. received a valid result). Each outcome was dichotomous, and independent variables (i.e. participant characteristics) were categorized to ensure adequate cell size. Relationships among independent variables and outcomes were first explored using bivariate binary logistic regression. If a significant relationship (in any direction) was identified at p<0.1, the variable was retained for multivariable analysis using hierarchical binary logistic regression. Each outcome was explored separately, and only variables significant at p<0.05 were included in the final models. Goodness of fit was assessed using the Hosmer-Lemeshow test. Cases with missing data were deleted listwise. SPSS v.26 was used for analysis.


Phase 1 of our study lasted from July 20, 2020 to April 1, 2021. During this time, 1,268 persons submitted the eligibility screening test, averaging 160 accesses per month; 47.3% (n=600) were eligible to register for a self-test. Notably, 59.1% (n=395) of persons were ineligible after submitting incomplete data. Among the 273 persons with complete data, 14.3% (n=39) were ineligible for multiple reasons and the rest for single reasons. As summarized in Table 1, residing outside Ottawa was the most common reason for ineligibility, followed by pre-exposure prophylaxis use.

Table 1: Reasons for participant ineligibility for HIV self-testing for program
Reason for ineligibility Number of individuals
(non-exclusive)Table 1 Footnote a
% of individuals
(non-exclusive)Table 1 Footnote a
Number of individuals
% of individuals
Live outside Ottawa 150 49 125 51
On PrEP 85 28 67 27
No cell phone 32 10 26 11
Younger than 18 years of age 17 6 10 4
HIV test result (indeterminateTable 1 Footnote b/positive) 10 3 7 3
Bleeding disorder 9 3 7 3
In an HIV vaccine trial 4 1 2 1

Of 600 eligible participants, 67.5% (n=405) completed a survey and ordered an HIV self-test. Six participants selected "prefer not to report" for all answers and were removed from the analysis. The remaining 399 participants were on average 32 years old, with 66% (n=264) reporting they were white, 68% (n=270) identifying as male, 57.4% (n=229) indicating they were gbMSM. As well, 57.1% (n=228) reported an income more than $40,000 and 77% reported having College or University level education (ongoing or completed). In total, 70.9% (n=283) of participants had one or more characteristic of an HIV priority group, which rose to 76.4% (n=305) when all racialized persons were included in this analysis (Table 2).

Table 2: Characteristics of eligible participants for program
Characteristic Description n %
Member of a priority population (n=399) Yes 283 71
No 116 29
Age (years) (n=395) 25 years or younger 110 28
26–49 years old 257 65
50 years and older 28 7
Ethnicity (n=399) Arab 16 4
Black 23 6
Indigenous 16 4
Latin 13 3
Mixed 22 6
South Asian 13 3
Southeast Asian 25 6
White 264 66
Gender (n=395) Men (includes transgender men) 270 68
Women (includes transgender women) 115 29
Gender non-conforming 10 3
Sexual orientation (n=390) Gay (all genders) 287 74
gbMSM 229 59
Straight 103 26
Income (n=348) Less than $20K per year 60 17
$20K–$75K per year 176 51
$75K+ per year 112 32
Education (n=391) High school of less 89 23
College or bachelor's degree 219 56
Advanced university degree 83 21
Has a primary care provider (n=392) Yes 264 67
No 128 33
Has completed prior HIV testing (n=398) Yes 290 73
No 108 27
Location of prior HIV testing (n=281) General practitioner's office 98 35
Public health clinic 154 55
Emergency Department or other hospital setting 6 2
Other 29 10
Number of sexual partners (n=382) 0 or 1 191 50
2–5 165 43
6 or more 26 7
Partners' HIV status (n=389) HIV negative (or no partners) 280 72
HIV positive 16 4
Unknown 93 24
Has a history of substance use (n=364) Yes 194 53
No 170 47

One hundred fifteen participants identified as women, with 24% (n=28) belonging to a priority group, which increased to 39% (n=45) when including women of any racial minority. When comparing participants who identified as men or women, there were significant (bivariate) associations between gender and eight characteristics. Women and men differed based on the following: 1) whether they were members of a priority group (p<0.001); 2) whether they identified as straight or gay (p<0.001); 3) whether they had a primary care provider (p=0.005); 4) whether they had prior HIV testing (p<0.001); 5) whether they were tested in a public health clinic (p<0.001); 6) whether they reported substance use (p=0.002); 7) whether they had more than one sexual partner (p<0.001); or 8) their age (p=0.029). When all significant characteristics were entered into a binary logistic regression model, only priority group status and number of sexual partners remained significant, with women being less likely to belong to racialized groups, use injection drugs and/or be a sexual minority (OR=0.04; 95% CI=0.02–0.08). Women were also more likely to report having fewer sexual partners than men (OR=0.47; 95% CI=0.25–0.92) (Table 3).

Table 3: Characteristics of eligible participants who had previously been tested for HIV
Characteristics Men Women Bivariate MultivariableTable 3 Footnote a [ref = first]
n % n % X2 p OR 95% CI
Lower Upper
Priority population
Member of a priority population 244 90 28 24 167.404 <0.001 0.04 0.02 0.08
White 177 65 79 69 3.977 NS N/A N/A N/A
Black or Indigenous 23 9 15 13
Other 71 26 21 18
Sexual orientation
Gay 229 85 53 47 58.970 <0.001 NS N/A N/A
Straight 41 15 60 53
Less than $20K per year 38 16 20 20 0.757 NS N/A N/A N/A
$20K to <$75K per year 120 51 48 48
$75K+ per year 78 33 32 32
High school 54 20 34 30 4.262 NS N/A N/A N/A
College or university 153 58 57 50
Advanced degree 59 22 22 20
Healthcare provider
Has a primary healthcare provider 168 63 88 78 7.837 0.005 NS N/A N/A
HIV testing
Has history of prior HIV testing 216 80 63 55 25.705 <0.001 NS N/A N/A
Location of testing
Public health clinic 131 63 16 26 28.076 <0.001 N/ATable 3 Footnote b N/A N/A
General Practitioner's office 57 27 38 62
Other 21 10 7 12
Number of sexual partners
0 or 1 102 39 80 72 34.334 <0.001 0.47 0.25 0.88
2 to 5 133 51 29 26
6 or more 24 7 2 <1
Partner HIV status
Negative or no partner 187 71 84 75 4.435 NS N/A N/A N/A
Positive 15 6 1 <1
Unknown 63 24 27 24
Substance use
Reported substance use 146 59 44 42 9.244 0.002 NS N/A N/A
Younger than 25 years 63 24 42 37 7.097 0.029 NS N/A N/A
26 to 49 years 182 68 67 58
50+ years 22 8 6 2

For HIV testing history, among all participants, 23.9% (n=95) reported no prior testing and an additional 3.3% (n=13/398) were uncertain if they had ever previously undergone HIV testing. Among the 290 participants who reported prior HIV testing, 59.6% (n=174) did so fewer than 12 months ago. For testing site (n=281 reported), 54.8% (n=154) indicated they were last tested in a public health or sexually transmitted infection clinic, 33.6% (n=98) tested with a primary care provider and 2.1% (n=6) tested in an emergency department or other hospital setting (Table 2).

Participants who have previously been tested for HIV were more likely to be older (p<0.005), identify as men (p<0.005), have 2–5 sexual partners (p<0.005) and know their sexual partners' HIV-status (Table 4). While 46% (n=50) of first-time testers were members of a priority population, 82% of all members of priority populations reported having previously completed HIV testing. Further, participants who were not members of a priority population were nearly five times more likely to be tested for HIV at a primary care provider clinic compared to a public health clinic (p<0.001; OR 4.71; 95% CI=2.39–9.27). These results identified differences in healthcare access for women versus men.

Table 4: Characteristics of eligible GetaKit participants who have previously been tested for HIV
Characteristic Interpretation Bivariate MultivariableTable 4 Footnote a [ref = first]
p OR 95% CI p OR 95% CI
Lower Upper Lower Upper
Priority population Members of priority populations more likely <0.05 4.74 2.95 6.64 NS N/A N/A N/A
Age 26–49 years old <0.05 4.85 2.96 7.93 <0.005 4.58 2.63 8.00
50+ years old more likely 4.86 1.72 13.71 9.13 2.64 31.49
Race No difference NS NS NS NS NS NS NS NS
Gender Women less likely <0.05 0.30 0.19 0.49 NS N/A N/A N/A
Sexual orientation Persons who identify as straight less likely <0.05 0.25 0.15 0.40 <0.005 0.33 0.18 0.58
Income Persons with a yearly income between $20K and $75K more likely <0.05 2.07 1.07 3.97 NS N/A N/A N/A
Education Persons with college/university education <0.05 2.62 1.56 4.43 NS N/A N/A N/A
Persons with advanced degrees more likely 3.92 1.93 8.00
Primary care No difference NS NS NS NS NS NS NS NS
Number of partners 2–5 <0.05 3.16 1.91 5.24 <0.005 2.89 1.57 5.32
6+ more likely 3.4 1.13 10.27 NS
Partner HIV status Persons who do not know partners HIV status are less likely <0.05 0.39 0.24 0.65 <0.005 0.28 0.15 0.53
Substance use Persons with a history are more likely <0.05 2.34 1.45 3.76 NS N/A N/A N/A
Reported result No difference NS NS NS NS NS NS NS NS

Overall, 57.1% (n=228) of participants reported their HIV self-test results back through, with 77.6% (n=177) being negative, 20.6% (n=47) being invalid, 1.3% (n=3) being "prefer not to report" and 0.4% (n=1) being positive. The positivity rate was 0.24% for all tests (n=1) and 0.44% for reported results (n=1). There were no significant relationships between participant characteristics and HIV test results. Participants who identified as straight were less likely to report their HIV test result compared to participants who identified as gbMSM (p<0.05; OR .58; 95% CI=0.37–0.91).


During Phase 1 of GetaKit, 1,268 persons assessed their eligibility; half were eligible, and one-third ordered a test. The most common ineligibility reason was living outside Ottawa. Nearly three-quarters of eligible participants (about one-quarter of eligible women) belonged to priority groups and nearly half of first-time testers were members of priority groups. Priority group participants were more likely to report results, compared with non-priority participants. About one-quarter of all eligible participants (almost one-half of women participants) reported no prior HIV testing. Over half of the participants reported their HIV self-test result back through the GetaKit website; most results were negative and one was positive, for a positivity rate of 0.24% (0.44% for reported tests) – compared to a baseline HIV positivity rate of 0.08% in Ottawa.

Consistent with previously published studies, our results highlight that an online ordering system for free HIV self-tests can facilitate testing for some persons affected by HIVFootnote 10Footnote 11Footnote 12Footnote 13Footnote 14Footnote 15. Supporting this assertion is that nearly three-quarters of our participants were members of a priority group and that our positivity rates were 3–5.5 times higher than the baseline rate in Ottawa. Notably, data from the local health unit indicated that, during the study period, there were 32 reported HIV diagnosis, of whom 13 had been previously diagnosed in other jurisdictions and were aware of their HIV-positive status. As such, GetaKit accounted for 5.2% (n=1) of new diagnoses in Ottawa during the Phase 1 study period. This outcome is likely related to the fact that over half of our participants identified as gbMSM, which is the group that accounts for over three-quarters of new HIV infections (defined as having been acquired within the preceding 12 months) in OttawaFootnote 16.


Our findings also highlighted facilitated access to testing for women who had not previously been tested for HIV. Indeed, nearly half of participants who identified as women indicated no prior testing. However, no women tested positive for HIV and only one-quarter of women belonged to priority groups—signalling that more efforts are required to target testing at women most at-risk for and affected by HIV. This would include women who are African, Caribbean or Black, Indigenous, use drugs, are transgender, and have other social/economic factors that increase their vulnerability to HIV. One reason why uptake was lower among women may have been the risk of violence associated with receiving an HIV self-test at-homeFootnote 17. Another reason for lowered participation in GetaKit may have been that women were accessing testing through traditional healthcare venues. That HIV prevention services are often targeted at gbMSM may have also affected uptake among women. Phase 2 of the GetaKit program includes curbside pick-up and ordering at discrete community locations, which will address inadvertent inaccessibly for women who are high-risk for HIV acquisition.

Another important limitation for this study was that it occurred during the coronavirus disease 2019 pandemic (COVID-19), when access to HIV testing services was limited. As such, people may have used GetaKit at a higher rate than would have occurred had healthcare settings been accessible. Conversely, the requirement for access to testing during the study period may have been lower if persons had restricted their sexual practices due to COVID-19 isolation protocols. As well, our findings about women may have been affected by the stepwise deletion process, as this reduced the analytic sample for women due to missing data. To address this, in Phase 2 we added more questions regarding persons who are transgender and gender non-conforming. Next, the proportion of women who belonged to priority groups may have been higher than we identified, as our Phase 1 survey did not inquire about sex work. This has been corrected for Phase 2. Lastly, that GetaKit operated exclusively through a website likely restricted access to persons with lower tech literacy or those who did not have ready access to computers. While COVID-19 restrictions did not allow in-person registration, paper-based surveys have been produced for Phase 2 and will be available at select on-site locations.


The GetaKit study was the first free mail-out HIV self-testing study in Canada. During Phase 1, we had good interest and uptake among member of the groups most affected by HIV in Canada and among persons never previously tested for HIV. While achieving such outcomes, GetaKit nevertheless seemed to have primarily reached more educated, higher income gbMSM, rather than the full spectrum of HIV priority groups. Thus, our findings highlight the importance of providing HIV self-testing in this manner, while also identifying the pressing need both to scale-up GetaKit to more regions and to reduce barriers to access (as will be addressed in Phase 2). Our findings also highlight the need to expand access to women who are most at-risk for HIV. This could occur through direct outreach and by having more discrete mechanisms for ordering and pick-up (Phase 2). Through such improvements, we may decrease the proportion of persons unaware they are HIV-positive and may help Canada move toward the United Nations 95-95-95 goals.

Authors' statement

POB is the principal investigator for GetaKit and was involved in all aspects of the project and article. AM was involved in all aspects of GetaKit and this article. AV was involved in all statistical analyses; she wrote all statistical text and reviewed and approved the final manuscript. NH was a research assistant for GetaKit, and was involved in data collection, article writing, editing, submission, and approval. LO was the HIV clinical lead for GetaKit and a research assistant for GetaKit, and was involved in data collection, article writing, editing, submission, and approval. MH was a research assistant for GetaKit, and was involved in data collection, article writing, editing, submission, and approval. VP was a clinician involved in GetaKit; she also oversaw all social media during phase 1 of GetaKit; VP was involved in data collection, article writing, editing, submission, and approval.

The content and view expressed in this article are those of the authors and do not necessarily reflect those of the Government of Canada.

Competing interests



POB would like to thank the Ontario HIV Treatment Network for his research chair in public health and HIV prevention. LO would like to thank the Canadian Institutes of Health Research for her Vanier Scholarship.


The Ontario HIV Treatment Network funded this project.

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