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

Abstract

BackgroundThe British Columbia Centre for Disease Control implemented a comprehensive Web-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver, Canada. GCO’s objectives are to increase testing for sexually transmitted and blood-borne infections (STBBIs), reach high-prevalence populations facing testing barriers, and increase clinical STI service capacity. GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a campaign to gay, bisexual, and other men who have sex with men (MSM).ObjectiveThe objective of the study was to report on characteristics of GCO users, use and test outcomes (overall and by promotional strategy) during this pilot phase.MethodsWe used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts during the first 15 months of implementation.ResultsOf 868 clients creating accounts, 318 (36.6%) submitted specimens, of whom 96 (30.2%) tested more than once and 10 (3.1%) had a positive STI diagnosis. The proportion of clients submitting specimens increased steadily over the course of the pilot phase following introduction of deferred tester codes. Clients were diverse with respect to age, gender, and ethnicity, although youth and individuals of nonwhite ethnicity were underrepresented. Of the 506 clients completing risk assessments, 215 (42.5%) were MSM, 89 (17.6%) were symptomatic, 47 (9.3%) were STI contacts, 232 (45.8%) reported condomless sex, 146 (28.9%) reported ≥4 partners in the past 3 months, and 76 (15.0%) reported a recent STI. A total of 63 (12.5%) GCO clients were testing for the first time. For 868 accounts created, 337 (38.8%) were by clinic invitations (0 diagnoses), 298 (34.3%) were by deferred testers (6 diagnoses), 194 (22.4%) were by promotional campaign (3 diagnoses), and 39 (4.5%) were by other means (1 diagnosis).ConclusionsOur evaluation suggests that GCO is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals unable to access immediate clinic-based testing suggest GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI. Motivation to test (eg, unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). Increased uptake and diagnosis corresponding with expansion of the service within British Columbia will permit future evaluation of this service across varying populations and settings.

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis

“…We completed semi-structured, one-to-one interviews with 37 key agents (HCP, administrators, policymakers, and community-based sexual health service providers) involved in GCO’s development. Another study explored the opinions and expectations MSM had of GCO during its development [ 14 ], and an analysis of users’ experiences with the pilot test of GCO in Vancouver indicated that 13% of clients who created GCO accounts were under age 25, suggesting that the program may need to be adapted or promoted in different ways to increase uptake amongst youth [ 32 ]. Interviews were conducted during the pre-implementation phase of GCO in Vancouver in 2013, prior to its launch in September 2014.…”

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*].…”

“…Given, criminalization of drug use, and stigma against PWIDs prevent their access to services [94], O2O models could be effective to scale-up HIV/HCV/STI testing/treatment and PrEP/PEP services. An integrated O2O model in Canada has successfully engaged 41 (8.1%) PWIDs in testing [30**]. In Italy, 2% (58/3046) of subjects completing online bookings and linked to sites were diagnosed with HCV [31**].…”

“…Omnichannel and seamless experiences as those offered by the Integrated O2O model are therefore key to service delivery in today’s digital age. Although all four types of O2O models summarized in this review represent potential in scaling-up clinical services, we particularly stress on the need for and recommend implementing and deploying Integrated O2O model (an emerging model with studies published recently in 2017), given its potential to address linkage barriers, fill significant programmatic gaps and demonstrate O2O linkage success [28*, 30**, 31**]. We summarize our findings on how providers in low and resource-limited countries could easily implement an Integrated O2O model (Box 1).…”