Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada

Abstract

BackgroundTesting for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one’s health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access.ObjectiveThis paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).MethodsFrom 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model.ResultsGCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO’s uptake, acceptability, and health system impacts is currently underway.ConclusionsGCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.

Use of GetCheckedOnline, a Comprehensive Web-based Testing Service for Sexually Transmitted and Blood-Borne Infections

“…Many outstanding questions remain about the individual, health service, and population impacts of GCO that cannot be answered using program data, including understanding the experiences of clients choosing to use GCO, how they compare with clinic clients in terms of risk of infection and testing barriers, and the impacts on testing patterns and prevention of ongoing transmission. We are currently undertaking a comprehensive program of research that will aim to answer these questions, as well as further confirm these preliminary, suggestive findings [12]. …”

“…Details of the development process and service pathway have been described in detail elsewhere [12]. In brief, use of GCO involves proceeding through 5 steps: (1) account creation, (2) start and complete a risk assessment, (3) create and print a laboratory form, (4) submit specimens, and (5) receive results.…”

“…Following extensive consultation, formative research, and usability testing, the British Columbia Centre for Disease Control (BCCDC) implemented a comprehensive Web-based testing service for chlamydia, gonorrhea, syphilis, human immunodeficiency virus (HIV), and hepatitis C virus (HCV), which is operated as an integrated extension of its provincial STI clinic [12]. Called GetCheckedOnline (GCO) [13], the service has three main objectives: (1) to improve sexual health by increasing the uptake and frequency of STBBI testing and earlier diagnosis; (2) to reach populations with a greater prevalence of infection and facing barriers to testing access, such as gay, bisexual, and other men who have sex with men (MSM), youth, and people living in rural areas; and (3) to increase the capacity of STI clinic services and allow clinical resources to be more focused on more complex STI cases (eg, through reducing wait times and asymptomatic client visits).…”

Online-to-offline models in HIV service delivery

“…Of 72 unique publications identified in our original search, 14 studies [18–19, 20*, 21*, 22*, 23*, 24*, 25*, 26*, 27*, 28*, 29, 30**, 31**,32*] met the inclusion criteria and were published between April 2015 and March 2017 (Table 1). Inclusion criteria included articles in English that reported data on impact of online interventions in increasing access to HIV and sexually transmitted infections (STIs) related information, reaching and engaging online key populations in HIV/STIs awareness and/or demonstrating testing and prevention services uptake.…”

“…Clients presented with the laboratory form to one of six designated sites in Vancouver where specimens were collected. Majority 73% of those who printed the lab forms actually submitted specimens [29, 30**]. The requirement to print a laboratory requisition was noted as a major barrier to service uptake and the study recommended barcode scanning from client’s smartphone as future alternative, similar to the strategy used in Thailand [28*].…”