E-Health for STI Control
In our Internet program www.iwantthekit.org (IWTK), women in Maryland, West Virginia, and Washington DC have been able to request home vaginal swab collection kits since 2004 via the Internet or a toll-free number. Other jurisdictions have been added over time. Beginning in 2006, men were added to the program and could requested free kits for home collection of urine and penile Self-obtained specimens were collected and mailed, and questionnaires were completed for demographics, acceptability and perceptions of use, and sexual risk history. Samples were tested using nucleic acid amplification tests. Self-collected rectal kits were made available in 2009. Infected participants were treated at participating clinics. As well, patients in our Emergency Department (ED) have been allowed to perform their own HIV test and are requesting a HIV test via an e-health kiosk. From 2008 to 2009, patients, who had completed a standard HIV oral fluid test performed by a trained healthcare professional and who were unaware of their results, were recruited to perform a rapid POC HIV test. In 2009-2110, patients were allowed to perform their own test before the standard of care HIV test.
Of 2689 female samples submitted from IWTK , 8.9% were positive for Chlamydia, 1.2% for gonorrhea and since 2006, 8.9% were positive for trichomonas. Prevalence for chlamydia in women aged 15-19 was 15.3% (11% in 20-25 year olds). High satisfaction was reported: 91% preferred self-collection; almost 97% said the collection was easy or very easy and 92% stated they would use the internet program again. Treatment was verified in all women except 4. Prevalence was higher than in family planning clinics. Of 927 men requesting kits, 29.1% mailed samples. Most (98.1%) submitted both penile swabs and urines. Chlamydia prevalence was 13.4%. Prevalence for those15-19 yr. was 20.6%, for 20-24 yr. was 18.1% and for 25-29 was 5.8%. Treatment was verified for all but 1 infected man. 93.0% of men found the instructions very easy/easy. Median age was 24 yr. Only 16.0% used condoms consistently. High satisfaction was reported: 86.7% preferred to collect his own specimen; 88.9% indicated the swab collection was easy/very easy and 87.5% stated they would use the Internet program again. In the ED HIV self test program, 478 of 564 (85%) patients receiving a standard oral fluid HIV test volunteered, with a mean age of 38-39 years. 91% of participants chose oral fluid and 9% chose blood (p<0.05). Self-test results were 99.6% concordant with health care professionals’ test results. For the self-testers, 94% of oral fluid testers and 84.4% of blood testers reported trusting the self-administered test result “very much.” 95.6% of oral fluid group and 93.3% of the blood group would “probably” or “definitely” perform a test at home, if available. A kiosk is now used in an ongoing study to recruit patients to accept an HIV test and provide an option to perform the oral fluid HIV self-test.
Self-collected samples recruited via the Internet and via an electronic kiosk approach appear to be acceptable, may remove barriers to testing, such as stigma and privacy issues, and may identify more sexually transmitted infections and cases of HIV than traditional venues if they can be more widely implemented. E-health for STI control has arrived.
