Health equity effects of digital interventions for sexually transmitted and blood-borne infection testing: A scoping review

Background: Digital interventions for sexually transmitted and blood-borne infections (STBBIs) testing have gained popularity as a potentially cheaper, farther reaching, and convenient STBBI testing modality especially for populations experiencing barriers to clinic-based testing. However, evidence of their health equity effects remains sparse. We reviewed the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects.

Methods: We followed Arksey and O’Malley’s framework for scoping reviews (2005) integrating adaptations by Levac et al. (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and gray literature comparing uptake (i.e., completion and return of test samples, repeat testing rates and frequency of testing) through digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between January 1st, 2010, and March 15th, 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socio-economic status (SES), Social capital, and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics.

Results: We included 27 articles from 7914 titles and abstracts retrieved from our search (Figure 1). Among these, 20/27 (74.1%) were observational studies, 23/27 (85.2%) described web-based interventions, and 18/27 (66.7%) involved postal- based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by any of the PROGRESS-Plus factors. Most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata. However, uptake was higher among women, white people with higher SES, urban residents, and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors potentially contributing to health equity in these interventions.

Conclusion: Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasizing the need to prioritize health equity in their design and evaluation.