Q&A: Barriers to STI self-testing among teens, young adults
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Key takeaways:
- Half of young adults in a survey said they would use a home-based STI test for convenience.
- However, many were concerned about administering the test and maintaining privacy.
Cost, discomfort with self-administration and privacy concerns are potential barriers to increasing the use of STI self-tests among adolescents and young adults, according to a study.
Although interventions by medical professionals have been shown to improve STI testing rates among teens, just one-fifth of sexually active adolescents and young adults reported being recently tested in a 2022 study. Additionally, nearly half of new STI diagnoses occur among adolescents and young adults, according to the CDC.
Katie Foug, BS, a doctoral student at the University of Michigan Medical School, Jayelin Parker, MPH, a research project manager in the Michigan Medicine Department of Obstetrics & Gynecology, and colleagues analyzed data on 700 adolescents and young adults aged 14 to 24 years who participated in the nationwide text message-based survey MyVoice.
Participants answered five open-ended questions on their perception of home-based STI testing. Almost half identified as female (45.4%) and most were white (62.6%).
Nearly half, 46.9%, said their primary reason for using a home-based test would be “convenience.” Participants cited concerns about home-based testing that included “test administration” (22.3%), “accuracy” (21%), “privacy” (18.7%) and “cost” (17%). Most respondents also said they would be willing to pay less than $50 for the test, according to the researchers.
We spoke to Foug and Parker about the analysis and how home self-testing for STIs might improve testing rates among young people. Their answers have been lightly edited for clarity and length.
Healio: What inspired this study?
Parker: Adolescents account for half the STIs in the United States, and that’s a problem. We need to figure out ways that adolescents and young adults would actually test, and find out the barriers to testing. What are the barriers? What do they like about different options of home-based testing or testing in clinics? How do they want a (home-based test) kit given to them? We need to find out before we implement things, because if it’s not actually what they want, then it’s not the right fit.
Healio: Are teens interested in home self-testing for STIs?
Parker: Teens were interested. There was a large number who said they would use self-collection STI kits at home, if it were free. However, they had a few concerns. Most of those were related to privacy — for instance, parents sometimes not giving kids packages that come in the mail. They want it to be private. They want to be able to dispose of the self-collection supplies and make sure they are sending it back appropriately.
They were also worried about self-collection itself and being able to do it appropriately, making sure that the results were accurate, making sure they know how to administer it and are doing the test correctly, because there isn’t anyone there to walk them through it. They want to make sure that they know what they’re doing and that, if they messed up, whether their results would be accurate.
Healio: Privacy is a big deal to younger people?
Foug: I think a lot of the responses we got about privacy were just generally being worried about having the STI kit with them. Maybe their roommate or a parent sees the package. It wasn’t so much related to the results — even just the notion that they’re testing themselves for an STI caused them to worry about privacy.
But the privacy thing also went both ways, because adolescents also noted that a benefit of home testing was it was like having another person complete the test for them in a clinic.
Parker: It was definitely both ways, and that’s why options [for testing] are key, because if the only way they’re going to test is at home, and that is more comfortable than going to a physician or an urgent care center, than that’s a good option, right? No option is going to be suitable for everyone.
Healio: What is the main takeaway of this study for clinicians?
Foug: Right now, STI screening rates for adolescents are very low. So, I think the takeaway for medical professionals is just to be educated about the option of at-home testing and offer that to those who might find it more appealing. Even beyond that, [it may be useful] to start getting these tests into schools or community programs just to increase access. STIs can have long-term consequences — they can affect fertility, they can cause long-term pelvic pain, etc. So, it’s another tool in the toolbox to help improve the STI screening rates for youths.
References:
- CDC. NCHHSTP Newsroom: Incidence, prevalence and cost of sexually transmitted infection in the United States, 2018. https://www.cdc.gov/nchhstp-newsroom/factsheets/incidence-prevalence-cost-stis-in-us.html. Published March 8, 2024. Accessed Sept, 24, 2024.
- Foug K, et al. Abstract 029. Presented at: Infectious Diseases Society for Obstetrics and Gynecology annual meeting; Aug. 1-3, 2024; Portland, Oregon.
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