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Rural, Remote and Indigenous Testing Collaborative

Learn about projects to improve access to diagnostic testing in rural, remote and Indigenous communities.

Last updated: August 12, 2024

We are a collaborative united by a common goal of improving access to diagnostic testing in rural, remote and Indigenous communities in British Columbia. 

Members of the collaborative 

  • BCCDC (host)
  • First Nations Health Authority
  • BC Children’s Hospital
  • National Microbiology Laboratory at the Public Health Agency of Canada 
  • Indigenous Services Canada. 
We initially began working together on a series of projects funded by a grant from the Public Health Agency of Canada from 2022-2024, which was focused on expanding diagnostic testing advancements made during the COVID-19 pandemic. As a result of the relationships and trust built through this work, we committed to our ongoing collective work together and to continue to identify opportunities for improving access to testing in rural, remote and Indigenous communities. 

Our values

  • Self-determination of Indigenous communities, who are at the heart of all projects, to be involved as they choose, and on their own terms.
  • Responsibility for listening to knowledge shared by communities – or questions asked – and taking action.
  • Following the seven sacred grandfather teachings: love, respect, bravery, truth, honesty, humility and wisdom.
  • Letse’mot, a (a Halq'eméylem word) meaning 'everyone working together', encompassing the idea that by cooperating in good faith we will achieve joint and shared decision-making in all decisions.
  • Having a learning spirit in everything we do.
  • Embrace and celebrate collaboration between our organizations.

Our way of working

  • Committed to communication, transparency and knowledge sharing. 
  • Working from a place of what is beneficial to individuals and communities, not the health system.
  • Engaging thoughtfully with communities and minimizing demands on their time.
  • Dedicating time to building and centring relationships, with each other and with communities.
  • Actively support each other, recognizing our members have multiple commitments.
  • Taking the time to ground ourselves and regularly reflect on our approach to the work.

Our projects

Kǝmtǝks Yakwa testing project

 
Our project title, Kǝmtǝks Yakwa, is Chinook Jargon, an Indigenous trading language and roughly translates to “Know or Knowledge Right Away”.  From this and in consultation with Indigenous partners we adopted the tagline for this project of “knowing means more choices.” 

The focus of this project was to engage Indigenous communities – particularly those that are rural and remote, using a distinctions-based approach - to determine interest and acceptability of sexually transmitted and blood borne infections (STBBI) testing options.  Our key priority is to honour the voices, preferences and identified needs of Indigenous peoples to develop culturally informed and self-determining testing options to increase prevention, detection, and engagement to care and ultimately reduce the burden of STBBI for Indigenous people. 

Initially the Chee Mamuk team met with communities participating in our Around the Kitchen Table training to receive direction on our potential questions which we then utilized. We then engaged in consultations with several rural, remote, and underserved urban Indigenous populations in B.C. regarding interest in and acceptability of STBBI testing options.  

As a result, the direction we have received during our engagements and gatherings has provided the primary guidance for our work, with corresponding research (regarding STBBI testing preferences and programs within Indigenous communities) synthesized around these priorities to provide added context and important background.  

 

 
 

Bring testing closer to home 

Increasing access to infectious disease diagnostic laboratory services beyond COVID-19 in rural and remote First Nation Communities in BC


 
During the COVID-19 pandemic, the First Nations Health Authority in British Columbia (B.C.) led an innovative initiative to strengthen testing capacity by facilitating the verification and implementation of molecular diagnostic testing in rural and remote First Nations communities. This unique Community Based Testing (CBT) program engaged over 20 communities across B.C. to help coordinate reliable “point of need” COVID-19 testing in some of the most remote regions of the province. Building on experiences of community based COVID-19 testing, there was interest in using this network to expand the scope of testing available in these settings for influenza A and B and respiratory syncytial virus. First Nations, particularly in northern and remote settings, are at higher risk from these respiratory viruses. Overall, bringing health services closer to home is in line with the Truth and Reconciliation Calls to Action for equitable access to high quality and culturally safe health care services.

There was a need to better understand local needs, feasibilities, challenges, and opportunities, including community support for expanding testing capacity of these platforms towards improved implementation and sustainability. The objectives of this project were to 
  1. Understand barriers to timely diagnostic services,
  2. Compile lessons learned to support optimizing the established CBT program for expanded scope, and
  3. Identify priorities for additional infectious disease testing on its platforms.
We conducted a systematic review of the barriers and facilitators to the implementation of community-based molecular based testing, to understand the current landscape of the literature globally, and in-depth interviews between January-June 2023 with eight frontline nurses to elicit their experiences implementing CBT at rural FNHA nursing stations. 

We found that while there was support for further scale up and expansion of testing, nurses highlighted the need to strengthen continuity of capacity and simplifying lab processes where possible.  The data generated from this project was used to apply for further funding to support studying and implementing self-collected sample types for respiratory illnesses. 

The findings indicate that self/parent-collected oral nasal swab samples provided accurate results and that caregivers were supportive of the process. These findings can help strengthen high-quality and culturally-safe diagnostic services in rural and remote First Nations communities across B.C.

 

First Nations Health Authority and the BC Children’s Hospital Department of Pathology and Laboratory Medicine.

 
 

Dried blood spot sampling evaluation and validation

 
This project aimed to evaluate the implementation of dried blood spot (DBS) sampling at pilot sites across the province to learn what worked well, what was challenging, and whether DBS sampling should be scaled up. 

DBS are a novel sampling approach for STBBIs in B.C., extending access for diagnosis and monitoring of infectious diseases. The method involves collecting small samples of blood through a finger prick, which are absorbed onto special filter paper. After DBS samples are processed in the laboratory, testing is run on the same molecular and serology instruments as phlebotomy samples. BC samples are currently being sent to Winnipeg for STBBI testing at the National Microbiology Laboratory. 

Since 2021, B.C. has been supporting a DBS sampling pilot for sexually transmitted and blood borne infections (STBBIs) supporting testing for HIV, hepatitis C, and syphilis. The DBS pilot evaluation built on key public health innovations emerging during the COVID-19 pandemic and sought to address challenges of inequitable access to STBBI testing, particularly in small urban, rural, and remote communities. 

In parallel, the BCCDC Public Health Laboratory worked to validate DBS as a sample type for STBBI tests so testing could be performed locally in B.C. instead of sending samples to the National Microbiology Laboratory (NML). The laboratory validation has been completed for HIV antibody/antigen and RNA (screening and diagnosis); hepatitis C antibody and RNA (screening and diagnosis); syphilis antibody (screening only); and hepatitis B antigen (active infection diagnosis only). 

Evaluation results suggest DBS can reach populations at higher risk for HIV, hepatitis C, and syphilis in less urban areas with a high-level of satisfaction. The evaluation of this pilot provides learnings on how to improve DBS sampling in B.C. 

 

BCCDC Public Health Laboratory and BCCDC Clinical Prevention Services

 

 
 
SOURCE: Rural, Remote and Indigenous Testing Collaborative ( )
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