Convenience and control—online sexually transmitted infection testing offers many benefits

Online sexually transmitted infection (STI) testing removes some of the barriers that prevent people from getting tested while still providing key information about health and wellness, according to users.

Researchers with the BC Centre for Disease Control (BCCDC) and University of British Columbia (UBC) published three studies evaluating the user experience of a free and confidential online testing called GetCheckedOnline, during the first few years of its operation.

GetCheckedOnline, provided by the BCCDC, tests for STIs and blood-borne infections such as HIV and hepatitis C. It is the first online sexual health service in B.C. and is available to people living in Metro Vancouver and, in partnership with Island Health and Interior Health Authorities, some parts of Vancouver Island and the Interior. More than 12,000 tests have been completed since it launched in 2014, and 43 per cent of people have used it for testing more than once.

"Users of GetCheckedOnline indicated that talking about their sexual activity with health care providers and fearing judgement and discrimination were some of the barriers that had kept them from getting tested previously," said Travis Salway, a postdoctoral fellow with the BCCDC who was involved in the research. "These barriers were more commonly reported by GetCheckedOnline users than by those who had gone to clinics for testing, indicating the online service is filling an unmet need for some people."

Rod Knight, an assistant professor in the UBC department of medicine, conducted interviews with gay, bisexual and other men who have sex with men to learn more about their experience with the service. This group often faces stigma in healthcare settings which can deter them from getting the HIV and other STI tests they need. They reported very positive experiences because they weren't required to see a clinician and discuss their sexual activity in order to get tested. The interviewees also said the online service gave them more autonomy throughout the testing process.

"They found the online service more flexible, more convenient and they liked the enhanced privacy," he said. "They felt more comfortable doing their own swabs and more control over how the testing occurs."

While online health care is expected to be more convenient for users, there are concerns that it won't deliver the same opportunities to educate patients about their health, well-being and preventative measures. One of the studies compared clients' knowledge of HIV, testing and prevention among clinic visitors and GetCheckedOnline users. The researchers found that GetCheckedOnline users had equal knowledge of HIV as people who had gone to clinics for testing, even three months after testing.

"We want the online users to get all the information they would get in the clinic," said Salway. "We found that the online service delivers key information about HIV testing similar to how it would be delivered in the clinic."

Knight pointed out that while the online service is an important addition to sexual health services, it can't replace the clinics.

"The individuals I spoke to were also quite satisfied with clinic-based testing and wanted to be able to visit a clinic when needed," he said. "For example, if they tested positive for an STI then they would go to an STI clinic or see their doctor. With online services, we need good processes in place to connect clients with doctors when need be."

Some users also noted face-to-face visits provide opportunities to discuss other health matters and can lead to referrals for further care. Previous research from the BCCDC shows there is a growing interest in integrating mental and sexual health services.

"Some guys expressed concerns about missed opportunities to discuss substance use and mental health issues like anxiety about HIV," said Knight.

"I think we can say that the evidence is in: internet-based testing services like GetCheckedOnline are effective," said Mark Gilbert, medical lead for GetCheckedOnline at the BCCDC who was also involved in the research. "We are continuing our work to expand the service sustainably in B.C."

The studies were recently published in Sexually Transmitted Infections:

• Qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use GetCheckedOnline.com: a comprehensive internet-based diagnostic service for HIV and other STIs: https://sti.bmj.com/content/early/2019/01/12/sextrans-2018-053645
• Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada: https://sti.bmj.com/content/early/2018/02/15/sextrans-2017-053325
• Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic: https://sti.bmj.com/content/early/2019/01/12/sextrans-2018-053652.long

To use GetCheckedOnline, visit http://getcheckedonline.com, and follow these steps:

• Create an account. You will need a promotional code to set up your account. You will be asked to provide some personal information, including name, date of birth, gender, city and phone number. This is so the lab can process your samples and we can contact you about your results
• Give samples at a lab. Create a lab form in GetCheckedOnline and take it to a participating LifeLabs location on your mobile device. You will not be asked to show ID or your BC Care Card. At the lab, you will be asked to give a blood and/or urine sample, and you may be given a swab kit to take home.
• Get your test results. You will receive an email from GetCheckedOnline letting you know when your test results are ready. If any of your results are positive or inconclusive, a nurse will contact you to talk about treatment or retesting.

Your GetCheckedOnline account will be linked to your electronic chart at the Provincial STI Clinic at BCCDC using a unique number.