Background
GetCheckedOnline (GCO) is an internet-based testing service for sexually-transmitted and blood borne infections (STBBI), launched by the BC Centre for Disease Control (BCCDC) in 2014 and operated in partnership with regional health authorities. Clients have tested through GCO more than 12,000 times over the past four years.
A number of research and evaluation projects were designed to ensure a detailed understanding of how, why, and for whom the service is working. Recently, a series of publications in the journal Sexually Transmitted Infections were jointly released to describe what we know from the first wave of GCO users.[1-3]
Below is a summary of two of these studies, which offer evidence of testing-related barriers [1], HIV test knowledge, and condom use [2] reported by GCO clients, directly compared with reports from STI clinic clients.
Summary of evidence
In 2015-2016, we anonymously surveyed 321 STI clinic clients and 73 GCO clients, all of whom lived in Greater Vancouver.
Barriers to testing
We quantified clinic, provider, and societal barriers to testing and compared them between these two groups.[1] Barriers were identified as factors that caused people to delay STBBI testing in the past year. We found that the following barriers were reported more frequently by GCO clients than by STI clinic clients:
Clinic-level:
- Distance to a clinic: 28% of GCO clients versus 9% of clinic clients
- Inconvenient clinic hours: 41% (GCO) versus 23% (clinic)
Provider-level:
- Discomfort discussing sexual history with a provider: 39% (GCO) versus 22% (clinic)
- Discomfort with health care providers in general: 19% (GCO) versus 5% (clinic)
- Worry about being judged by provider when providing a sexual history: 30% (GCO) versus 15% (clinic)
Societal-level:
- Embarrassment related to testing for STI or HIV: 16% (GCO) versus 6% (clinic)
We also learned that GCO clients were older (median age 35 years) than clinic clients (median age 30 years), and that more GCO clients identified as gay, bisexual or a man who has sex with men (45%), as compared with clinic clients (16%).
Knowledge and behaviour
Acknowledging that testing online may result in missed opportunities for educational conversations between testers and providers, we compared the HIV testing knowledge and reported use of condoms of GCO and clinic clients.
We found that HIV test knowledge (measured using 6 items identified as critical pre-test information) was equivalent between GCO and clinic clients. Increases in condom use were greater among GCO clients than among clinic clients, as reported 3 months after testing.
Implications for practice
These results make a compelling case for the provincial expansion of GCO.
We found that GCO clients report multiple barriers that previously deterred them from testing. GCO is an efficient way to meet otherwise unmet sexual health needs, especially in the context of limited hours and locations of low-barrier STI clinics and societal stigmas attached to sexuality, HIV, and other STBBI.
We also found that developing comprehensive educational messages for GCO was associated with equivalent knowledge of core HIV pre-test information between online and clinic testers. There may be other topics that are typically addressed in conversation with sexual health providers (e.g., mental health, substance use, or other STBBI clinical interventions) that can similarly be integrated with the dynamic content of GCO.
For further information
Dig into the research we are doing to better understand how GCO is working.
Read about the third study in this suite of research from GCO’s first wave of users.
Acknowledgements
Thank you to Mark Gilbert, Devon Haag, and Kimberly Thomson for their leadership and vision in administering GetCheckedOnline.com and the associated suite of research. We are also grateful to the hundreds of GCO clients who shared their experiences with us to make this research possible.
References
- Gilbert M, Thomson K, Salway T, Haag D, Grennan T, Fairley CK, Buchner C, Krajden M, Kendall P, Shoveller J, Ogilvie G. (2018) Differences in experiences of barriers to STI testing between clients of the internet-based diagnostic testing service GetCheckedOnline.com and an STI clinic in Vancouver, Canada. Sex Transm Infect Published Online First: 7 February 2018. Doi: 10.1136/sextrans-2017-053325. https://sti.bmj.com/content/early/2018/02/15/sextrans-2017-053325
- Salway T, Thomson K, Taylor D, Haag D, Elliot E, Wong T, Fairley CK, Grennan T, Shoveller J, Ogilvie G, Gilbert M. (2019) Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic. Sex Transm Infect Published Online First: 13 January 2019: Doi: 10.1136/sextrans-2018-053652. https://sti.bmj.com/content/early/2019/01/12/sextrans-2018-053652
- Knight R, Chabot C, Carson A, Thomson K, Haag D, Gilbert M & Shoveller J. (2019) A qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use GetCheckedOnline.com: A comprehensive internet-based diagnostic service for HIV and other STIs. Sex Transm Infect Published Online First: 13 January 2019. Doi: 10.1136/sextrans-2018-053645. https://sti.bmj.com/content/early/2019/01/12/sextrans-2018-053645.full