A review of internet-based testing services for HIV and sexually transmitted infections (STIs)

Key take-home messages

• The integration of digital technologies into HIV and STI testing is becoming more prevalent, and appears to influence testing behaviours.
• Three models offering online HIV/STI testing that do not require a face-to-face visit with a healthcare provider have been identified: by ordering a test kit online and having it delivered via mail, by ordering a self-collection kit online, having it delivered via mail and returning it, or by generating a laboratory requisition online or scheduling specimen collection at a lab.
• In high-income settings examined in this review, a large variety of online HIV/STI testing services are available. In Canada, GetCheckedOnline (British Columbia), GetAKit (Ontario), and I’m Ready (Canada-wide) offer free testing for HIV and/or STIs; test kits can also be ordered for a fee from manufacturers’ or other commercially available website. In the UK, numerous publicly-funded services offer free online ordering of HIV/STI self-testing kits and/or self-collection kits. It appears that in the U.S., most of these services are offered privately and require payment.
• Online HIV/STI testing has been found to be acceptable and of interest in several studies across different settings.
• Some studies reported that in-clinic diagnosis rates appear to be comparable to online diagnosis rates, but one study found that online diagnosis rates were lower, as those with symptoms were encouraged to test in-clinic.
• Internet-based HIV/STI testing services are used by a wide variety of population groups including men who have sex with men, young adults, heterosexual men and women, transgender and non-binary individuals, people with a history of drug use, and people with limited access to traditional testing facilities.
• Some online testing services utilized targeted advertising such as Grindr, Facebook, Instagram, and community HIV prevention sites to encourage testing among populations at higher risk.
• One report examining the impact of GetCheckedOnline found that generally, the majority of users indicated engaging in behaviours that may lead to a higher chance of infection (e.g. condomless intercourse, multiple partners).
• Services may employ different ways to assess HIV/STI risk. For example, one Canadian and one UK service report that symptomatic individuals are encouraged to test in-clinic with a healthcare provider; one U.S. service requires users to disclose date of last test, and one service in Italy requires users to fill out a risk-assessment form.
• One study from the UK found that that offering online HIV and STI testing changed individuals’ testing patterns in a geographic area with unmet needs. Authors found that while introducing online STI testing increased the number of tests, cost of testing, and total number of diagnoses, the average cost per diagnosis decreased. After two years, total diagnoses increased, with online testing accounting for 37% of all testing.
• Ordering HIV self-test kits and STI self-collection kits via mobile apps was found to be feasible and acceptable in pilot trials, and may be a way to increase HIV/STI testing among young men who have sex with men.

• Population(s)
  • General HIV+ population
• Prevention, Engagement and Care Cascade
  • Prevention
• Prevention
  • Education/media campaigns
• Testing
  • Testing