Digital interventions for sexually transmitted and blood borne infections (STBBI) testing might replicate or create new inequities in access. While GetCheckedOnline (GCO), a digital service for STBBI testing in British Columbia (BC) has been shown to improve testing access in the province, assessing the equity of its outcomes is essential to ensure service appropriateness and accessibility. This analysis aimed to assess the association between sociodemographic characteristics and differences in awareness and use of GCO in communities where it is available outside Vancouver, BC.
From July to September 2022, we conducted a cross sectional survey in 5 communities (Kimberley, Kamloops, Maple Ridge, Nelson, and Greater Victoria), recruiting in person and online with oversampling of populations experiencing increased barriers to STBBI testing. Eligible participants were BC Residents ≥16 years old, and sexually active (≥1 oral, anal or vaginal intercourse in the past year). We studied the association between use and awareness of GCO and age, gender identity, sexual identity, race/ethnicity, educational attainment, and income, using directed acyclic graph (DAG) informed logistic regression models.
Our sample comprised 1,658 individuals. A large proportion of this sample represented people from equity owed groups (Table 1 in the expanded poster). 66.8% (990/1483) reported experiencing barriers to accessing provider based testing in the past year (e.g., long wait times). Overall implementation outcomes: 35.3% (586/1,658) were aware of GCO, of whom 56.3% had used the service (324/576), which corresponded to 19.5% (324/1,658) of the sample.
Some groups showed a higher likelihood of both awareness and use, including those identifying as lesbian, gay, bisexual and other non non-heterosexual people (LGB+) and People of Color (Table 2 in the expanded poster). A lower likelihood of awareness and use was found in the lowest income group (annual income <$20,000) and people in younger (<25 years) and older (>38 years) age categories. Women and Indigenous participants did not have a higher likelihood of use despite higher or similar levels of awareness than their corresponding reference groups.
- Differences in awareness and use between sociodemographic groups point to a complex pattern of GCO outcomes distribution.
- Some differences favoured equity owed groups (i.e., People of Color, LGB+, and transgender people), while others favoured privileged
groups (i.e., income, men compared to women).
- Community specific balances of relative advantage of GCO over provider based testing and communication networks may account
for the differences observed in this study.
- Further comprehension of these differences is necessary to guide service promotion and adaptation to improve equity indicators.