Use of GetCheckedOnline, a comprehensive web-based testing service for sexually transmitted and blood-borne infections

Background
The British Columbia Centre for Disease Control implemented a comprehensive internet-based testing service GetCheckedOnline (GCO) in September 2014 in Vancouver. GCO’s objectives are to  increase testing for sexually transmitted and blood-borne infections (STBBI), reach high prevalence populations facing testing barriers, and increase clinical sexually transmitted infection (STI) service capacity. During the first fifteen months of implementation, GCO was promoted through email invitations to provincial STI clinic clients, access codes to clients unable to access immediate clinic-based testing (deferred testers), and a promotional campaign to gay, bisexual and other men who have sex with men (MSM).

Objective
To report on characteristics of GCO users, and use and test outcomes (overall and by promotional strategy) during this pilot phase.

Methods
We used GCO program data, website metrics, and provincial STI clinic records to describe temporal trends, progression through the service pathway, and demographic, risk, and testing outcomes for individuals creating GCO accounts between September 2014 and December 2016.

Results
Overall, of 868 clients creating accounts 318 (37%) submitted specimens, of whom 96 (30%) tested more than once and 10 (3%) were diagnosed with an STI. The proportion of clients submitting specimens increased steadily over the course of the pilot following the introduction of codes for deferred testers. GCO clients were diverse with respect to age, gender and ethnicity, although youth and individuals of non-White ethnicity were under-represented. Based on 506 clients completing risk assessments, 42% were MSM, 18% were symptomatic, 9% were STI contacts, 41% reported condomless sex, 27% reported ≥ four partners in the past three months, and 15% reported a recent STI. Eight percent of GCO clients were testing for the first time. For 868 accounts created, 39% were by clinic invitations (0 diagnoses), 34% were by deferred testers (6 diagnoses), 22% were by promotional campaign (3 diagnoses), and 4% were by other means (1 diagnosis).

Conclusions
Our evaluation of GCO’s pilot phase suggests that the service is an acceptable and feasible approach to engage individuals in testing. Use by first-time testers, repeated use, and STI diagnosis of individuals not able to access immediate clinic-based testing suggests GCO may facilitate uptake of STBBI testing and earlier diagnosis. Use by MSM and individuals reporting sexual risk suggests GCO may reach populations with a higher risk of STI infection. Motivation to test (e.g., when unable to access clinical services immediately) appears a key factor underlying GCO use. These findings identify areas for refinement of the testing model, further promotion, and future research (including understanding reasons for drop-off through the service pathway and more comprehensive evaluation of effectiveness). GCO has since expanded to other regions in BC with a corresponding increase in uptake and diagnoses which will permit evaluation of this service across varying populations and settings.