A Longitudinal Evaluation of Testing Utilisation and Over-Recommendation in GetCheckedOnline
Research theme(s)
Internet Based Testing
Pierce Gorun, Sofia Bartlett, Lang Wu, Ihoghosa Iyamu, Hsiu-Ju Chang, Troy Grennan, Mark Gilbert.
BC Centre for Disease Control Research Week 2025, Vancouver, BC, November 3-7, 2025.
Background
Sexually transmitted and blood-borne infection (STBBI) rates have risen, disproportionately affecting equity-deserving populations who face barriers to testing. BC’s digital STBBI testing service GetCheckedOnline (GCO) expands access, however, funding constraints have stalled further expansion. As a cost-saving measure, decision-makers have considered reducing potentially unnecessary testing. Currently, GCO routinely recommends chlamydia, gonorrhea, syphilis and HIV tests for all clients, warranting exploration of over-recommendation. This thesis examined GCO utilisation by demographic and behavioural characteristics and explored the extent of potential over-recommendation based on clinical guidelines
Methods
A retrospective cohort study was conducted using GCO program data of repeat testers from September 2014 to December 2024. Self-reported demographic and behavioural characteristics, aligned with the Andersen Healthcare Utilisation model, were used to explore associations with repeat testing and potential over-recommendation. Andersen-Gill survival models estimated risks of repeat testing, and negative binomial regression estimated rates of potential over-recommendation. Positivity rates were compared across recommendation categories.
Results
Among 25,728 repeat clients, repeat testing was positively associated with racialised clients, reporting no condom use, multiple partners, previous STBBI diagnosis, and partners reporting STBBIs. Negative associations were observed for clients under 30 and those reporting symptoms, while gender identity and client-partner gender groups showed time-varying effects. Most potential over-recommendations (96%) occurred when clients tested within three months of a previous episode. Overall, 27.8% of screening episodes were classified as potential over-recommendations, with lower rates among women, those with unknown gender identity and older adults, and higher rates among racialised clients, and those reporting no condom use, multiple partners, and previous STBBI diagnosis. Positivity was higher among potential over-recommendations (4.1%) than non-over-recommendations (3.5%, p < 0.01).
Conclusions