Home-based STI testing addresses barriers, but many programs are not tailored for youth
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SAN DIEGO — Results of a scoping review showed that home-based testing for sexually transmitted infections addresses important barriers that often prevent young people from seeking care, but few programs are tailored for youth.
Self-testing for STIs became increasingly popular during the pandemic as testing clinics shut down, according Saumya Sao, BA, a clinical researcher from the department of gynecology and obstetrics at Johns Hopkins School of Medicine. Moreover, the CDC recently reported that STIs continued to surge during the pandemic, making testing and linkage to care even more important.
“Self-collected, mail-in STI testing addresses a lot of barriers to STI testing that are specific to youth, just because of its innate nature,” Sao told Healio.
For example, she said, “it solves the issue of transportation,” as well as that of privacy and the need for confidentiality.
Six months ago, Sao and Jenell Coleman Fennell, MD, MPH — the director of the division of gynecologic specialties and associate professor of obstetrics and gynecology at Johns Hopkins — launched their own STI testing platform called the The Violet Project, which is specifically geared toward teens.
“To inform the development of the platform and to see what the existing landscape looks like, we conducted this scoping review,” Sao explained.
Sao and colleagues reviewed more than a dozen programs that offer self-collected, mailed STI tests.
“The categories we looked at were specific to the unique needs of youth, aged 13 to 24 years,” she said. The categories included cost, whether the platform linked the user to a clinician and if there were additional costs because of that, whether the packaging was discreet and if there were any age restrictions.
The researchers gave each program a rating, depending on whether it was tailored to youth.
“Hardly any programs are,” Sao said, “but they may certainly improve access to STI testing for an older population.”
The results also showed that out-of-pocket expenses were “on the higher end,” according to Sao. For example, only three programs had free testing, and the rest charged between $45 and approximately $180 to test for chlamydia and gonorrhea. The tests grew even more expensive if they covered other STIs and HIV. Few of the programs connected users to a clinician, and even fewer did so for free. Also, many of the programs did not show what the packaging of the tests looked like on their websites, potentially discouraging young people from requesting them, and most had age restrictions.
“We took all of these gaps into consideration when we created The Violet Project's testing platform,” Sao said.
Even though several of the programs failed to address some important barriers to STI testing such as cost and linkage to care, Sao emphasized that any increase in access to health care is a good thing.
“Self-collect STI testing is great for people who may be particularly marginalized or feel stigmatized in a health care setting because they can do it in complete privacy,” she said. “Self-collect STI testing can also be encouraged by clinicians to make sure that people who test positive in a clinic comply with retesting after 3 months. It also allows a lot of flexibility for people who cannot accommodate taking time off work or finding child care to come in for a clinic appointment. However, we did feel that it was important to create a new platform that was specifically tailored to youth, just because that population has some unique needs. So, the increase in access with all of the platforms we found is great, but we did feel a need to extend that access to something specific for youth.”