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Reasons individuals initially engaging with an online sexually-transmitted and blood-borne infection (STBBI) testing service do not test: implications for service design and implementation

Research theme(s)
Internet Based Testing

Aidan Ablona1, Ihoghosa Iyamu1,2, Hsiu-Ju Chang1, Paul Flowers3, Travis Salway4, Nathan J. Lachowsky5,6, Devon Haag1, Heather Pedersen1, Darren Ho6, Troy Grennan1,2, Daniel Grace7, Cathy Worthington5, Mark Gilbert1,2

1BC Centre for Disease Control, Vancouver, Canada, 2University of British Columbia, Vancouver, Canada, 3University of Strathclyde, Glasgow, UK, 4Simon Fraser University, Burnaby, Canada, 5University of Victoria, Victoria, Canada, 6Community-Based Research Centre, Vancouver, Canada, 7University of Toronto, Toronto, Canada

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

Background: Some individuals initially engaging with online STBBI testing services do not complete testing. For example, they have registered or created an account with the service, and do not take their lab form to a lab to submit specimens, or order a self-collection kit and do not return it. If these individuals were looking to get tested at the time, this may reflect missed opportunities for testing. However, we don’t understand the reasons why this happens, and it may be related to features of online testing services that could be modified or adapted. We studied this question among people creating an account on GetCheckedOnline, British Columbia’s online STBBI testing service where users generate lab forms to take to local labs for specimen collection. Our goal was to identify whether any changes to the service design or implementation could help reduce missed opportunities for testing. 

Methods: Between Nov 21 – Dec 6, 2022, we invited users of GetCheckedOnline who had consented to be contacted for research, were ≥ 16 years, and who had created an account in the 6 months prior to data collection to complete an online survey. The survey asked about STBBI testing experiences, use of GetCheckedOnline, perceptions of access to services, and socio-demographics. In our analysis, we focused on the participants who reported needing testing at the time of creating their account but did not complete testing. We descriptively analyzed the characteristics of these participants (excluding missing responses).

Results: Overall, 3128 account holders were invited and 681 (22%) completed the survey. The majority (84% (572/681) of participants reported needing to test when they created their account (Figure 1). Overall, one-third (32%, 183/572) of participants needing to test did not complete testing. 

Figure 1: Participants’ progression to testing after creating an account through GetCheckedOnline


Of the participants needing but not completing testing:

  • Median age: 31 years old
  • 62% (96/156) identified as women, 29% (45/156) identified as men, and 10% (15/156) did not exclusively identify as women or men
  • 52% (83/159) identified with a non-heterosexual sexual identity
  • 4% (6/157) identified as Indigenous (i.e., First Nations, Inuit, or Métis), 61% (97/157) identified as White only, and 34% (54/157) identified as a non-Indigenous ethno-racial minority
  • 75% (126/169) reported at least one provider-based STI testing barrier in the past year
  • 37% (58/158) agreed that provider-based testing was easily accessible
  • 36% (57/158) agreed they had a usual place where they were comfortable getting tested by a provider. 
  • 49% (77/158) reported having at least 4 sex partners in the past year
  • 40% (60/150) had condomless vaginal or anal sex with more than 1 partner in the past 3 months
  • 45% (75/157) were diagnosed with an STBBI in the past year

Reasons for not proceeding to test through GetCheckedOnline included (n=170, excluding missing responses): 

  • 26% opted for provider-based testing (e.g., recommended by GCO, wanted to speak to MD or RN, had other opportunity to get tested)
  • 21% had challenges getting tested at participating laboratories (making appointment, wait time, no way to print form or show on phone)
  • 19% did not get around to taking lab form to a lab
  • 15% did not have a participating laboratory location near them where they could provide specimens
  • 9% had challenges understanding how service or process worked
  • 8% had issues related to tests offered (did not have tests looked for, didn’t want to provide specimens needed)
  • 16% reported other reasons (trust, privacy, comfort with questions, difficult to use, other)

Overall, 86% (138/161) agreed they would test through GetCheckedOnline in the future. 

Conclusions: In this exploratory study, a quarter of people needing but not completing testing through GetCheckedOnline chose provider-based testing instead. However, many reported reasons related to the design and implementation of the service, some of which may be overcome by program adaptations and improvements. For example, adding text/email reminders to submit specimens may help for people not getting around to taking forms to a lab, changing educational content to help explain how the service works, or implementing at-home self-collected sampling kits to help overcome challenges related to submitting specimens at a lab.