New Rapid TLC initiative from St. Michael’s Hospital brings fast, same-day HIV and STBBI testing and treatment to communities often left behind

A new national initiative is breaking down barriers to HIV and sexually transmitted and blood borne infection (STBBI) testing in Canada—delivering same-day results and immediate care and treatment directly into communities that need it most. Rapid Testing and Linkage to Care (Rapid TLC), led by REACH Nexus at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions, is bringing fast, accessible, community-based testing and seamless pathways to care to underserved populations across the country.

In Canada, barriers such as long travel distances, limited clinic availability, lab delays of up to 10 days, and structural factors like racism, stigma and trauma from residential schools have made timely access to testing difficult—especially in rural and remote areas and for Indigenous communities. At the same time, rates of HIV, syphilis, hepatitis C, chlamydia, and gonorrhea continue to rise, disproportionately affecting First Nations, Inuit, and Métis communities, Black communities, and people who use substances.

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Rapid TLC addresses these gaps by bringing testing, care and treatment directly into community settings. The program is powered by 56 of Cepheid’s GeneXpert® systems, supplied by the Public Health Agency of Canada (PHAC). These portable diagnostic systems function like mobile laboratories, delivering lab-quality results for HIV and other STBBIs in under 90 minutes, decreasing long wait times and reducing the risk of individuals being lost to follow-up. People can become disengaged while waiting for their test results due to fragmented care pathways, long wait times, stigma, unstable living conditions, and communication barriers, making it difficult to return for care and treatment.

 “This public health intervention is about turning a moment of testing into a moment of action, so people get answers, support, and care the same day, no matter where they live,” said Dr. Sean B. Rourke, director of REACH Nexus at St. Michael’s Hospital, a site of Unity Health Toronto. “This is about strengthening connections to culturally safe care – and providing this with supports from health care providers and health navigators that can help regain the trust of affected communities.”

The initiative is supported through a strong national partnership: PHAC has supplied the GeneXpert systems, the PHAC National Microbiology Laboratory (NML) is facilitating training and quality assurance; and the Canadian Institutes of Health Research (CIHR), Indigenous Services Canada (ISC) and the Canadian Foundation for AIDS Research (CANFAR) are providing additional program support.

“CANFAR is proud to support the launch of Rapid TLC, bringing faster, more accessible diagnostics directly into communities,” says Dr. Paul Sandstrom, newly appointed CEO of CANFAR. “Aligned with our Bold Actions plan to end HIV in Canada, this initiative reduces barriers to testing and advances health equity for under-resourced communities. With donor support, we’re expanding rapid testing technologies and linkage to care initiatives through community partners such as Women’s Health in Women’s Hands to improve early detection and strengthen responses to HIV and other STBBIs.”

Rapid TLC is currently being implemented across more than 10 community-based sites nationwide, with plans to recruit approximately 2,500 participants.

“Cepheid is proud to support innovative programs like Rapid TLC, a powerful example of how innovative technology can help close critical gaps in care and reach underserved communities, while reducing HIV and other STBBIs,” said Scott Sugden, director of medical affairs at Cepheid Canada.

In this first phase of implementation, two Rapid TLC sites—Women’s Health in Women’s Hands Community Health Centre and Anishnawbe Health Toronto—have begun using the GeneXpert systems to help expand culturally safe, community-based testing and care for Black and Indigenous communities disproportionately impacted by HIV.

“For too long, Black communities have been left navigating a healthcare system that wasn’t built with them in mind—where stigma, barriers, and missed opportunities delay care. Rapid TLC is about changing that by bringing trusted, community-led testing and support directly to people, so no one is left behind,” said Wangari Tharao, Director of Research and Programs at Women’s Health in Women’s Hands.

“This partnership represents an important step forward in expanding access to low-barrier, culturally grounded HIV and STBBI testing and care for Indigenous communities. By strengthening rapid test linkage to care and confirmatory pathways, we are helping to ensure that individuals can move quickly from diagnosis to support and treatment,” said Michael Milward, Executive Director, Anishnawbe Health Toronto.

The Rapid TLC model is built on four core components:

  • Rapid, point-of-care testing (screening) with confirmatory results using GeneXpert systems delivered in a single visit
  • Immediate linkage to care, connecting individuals to treatment, prevention, and support services without delay
  • Community-led partnerships with Indigenous organizations, outreach teams, shelters, and harm reduction programs to ensure culturally safe, trauma-informed care
  • Ongoing evaluation and data collection to measure impact, health outcomes and support scale-up in high-need communities

The initiative also includes an embedded study evaluating a new HIV diagnostic tool to further enhance rapid testing approaches in real-world settings. By closing the gap between testing and treatment, Rapid TLC represents a major step forward in Canada’s efforts to reduce health inequities and move closer to ending HIV and STBBIs as public health threats.