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Online and provider-based testing for sexually-transmitted and bloodborne infections: describing patterns of use among repeat testers in British Columbia, Canada

Research theme(s)
Internet Based Testing

Mark Gilbert1,2, Aidan Ablona1, Ihoghosa Iyamu1,2, Hsiu-Ju Chang1, Heather Pedersen1, Paul Flowers3, Nathan Lachowsky4, Travis Salway5, Troy Grennan1,2, Devon Haag1, Cathy Worthington4, Daniel Grace.7

1. British Columbia Centre for Disease Control, 2. University of British Columbia, 3. University of Strathclyde, 4. University of Victoria, 5. Simon Fraser University, 6. Division of Infectious Diseases, University of British Columbia, 7. University of Toronto.

STI & HIV World Congress 2023, July 24-27, 2023, Chicago, IL, USA.


  • The scale-up of online testing services for sexually transmitted and bloodborne infections (STBBI) is changing the testing landscape in many countries, yet questions remain about how people use these services in relation to ongoing testing through healthcare providers.
  • From a health system decision-maker perspective, these questions are critical to answer (e.g., to understand the impact these services have on health care provider workload, or if tests conducted would have occurred if the service were not available). 
  • GetCheckedOnline (GCO) is a digital STBBI testing service in British Columbia, Canada which allows users to access a lab form and visit a lab to submit specimens, without first seeing a health care provider. The service includes testing for HIV, hepatitis C, syphilis, gonorrhea and chlamydia, with centralized handling of all positive results through the provincial STI clinic. 
  • In 2022, 16,223 people tested through GCO across 8 cities where the service is available, and 38% were people who had tested two or more times through the service. 
  • Our objective was to determine the patterns of using GCO and provider-based testing among repeat users of the service. 


  • We identified eligible GCO users who were ≥ 16 years and regular testers through the service, which we defined as: creating an account before April 2022, and testing two or more times with at least one test between April and October 2022. 
  • All eligible users who consented to be contacted for research were sent an invitation to an online survey between November 21 and December 6, 2022. 
  • Survey domains included patterns of testing through GCO and providers, perceptions of these testing modalities, as well as variables related to accessing provider-based testing services. 
  • Participants were provided with a $20 CDN honorarium, and the survey was approved by the UBC Behavioural Research Ethics Board. 
  • Characteristics, testing patterns and preferences of participants were described. To adjust for non-response bias, we applied post-stratification weights based on the age, gender identity and number of GCO tests completed of all eligible users.


  • We invited 1798 users to the survey, of whom 789 (44%) participated and were included in the analysis. 
    • Participants had a median age of 33 years, 11% had a gender identity that was not man or woman (only), 45% were straight/heterosexual, and 68% were White. 
    • 59% had a Bachelor’s degree or higher, 64% were employed full-time, 34% earned less than 40 K per year, and 12% were newcomers (had immigrated in past 5 years). 
  • Over half (53%) of participants reported only testing through GCO, with a minority testing equally or mostly through providers.

Patterns of testing:


Reasons for testing through a healthcare provider

(HCP; excludes participants saying they only tested through GCO)


Access to provider-based testing:

  • 32% disagreed had a usual place they were comfortable going to get tested by a provider.
  • 51% disagreed it was easy to get tested by a provider when they needed to. 
  • 33% did not have a family doctor or nurse practitioner. 
  • 11% said they would not have gotten tested if GCO were not available. pastedGraphic_2.png
  • The majority (86%) of participants agreed or strongly agreed that they tested sooner, and more often, through GCO compared to healthcare providers 


  • Our study is one of the first to examine patterns of digital and provider-based testing among regular users of a digital testing service, and demonstrates public health and health system value that supports continued scale-up of GetCheckedOnline
  • Half (47%) of participants in our survey test both online and through healthcare providers, commonly testing through providers when convenient or clinically indicated (e.g., symptoms, PrEP)
  • Many repeat users of GCO have access to provider-based testing, yet have shifted to online testing, reducing demand on providers for testing and avoiding healthcare costs. Others may not be able to access provider-based testing, improving access to testing overall
  • GCO facilitates earlier and more frequent testing, which may lead to earlier diagnosis, treatment and prevention
  • Our sample was majority White, educated, and higher income calling for further study of the relationship between measures of social location and privilege and patterns of testing through GCO