Online Mediated STI Testing Scores Well on Usability and Acceptability, Lowers the Threshold for Testing and Increases Test Capacity
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Abstract
Background: Routine testing of asymptomatic men who have sex with men (MSM) is important for decreasing STI and HIV transmission. To motivate more MSM to get tested, we developed an online testing services called Test-Lab to lower the threshold for STI testing by enabling MSM to initiate anonymous and free testing without the mediation of a doctor or a visit to STI clinics. In this paper we present the evaluation of this service for usage, usability, acceptability and efficacy in attracting a high risk population.
Methods: Through a national sexual health website for MSM, mantotman.nl, men can arrange a complete test package for Chlamydia, Gonorrhea, Syphilis and HIV at an accredited testing lab. Results can be later obtained online and men found positive are referred to STI clinics for direct treatment. Data on usage of the service was collected for 11 months. To determine the efficacy of the test service we compared the rate of positive serology found in the online sample with a sample of MSM who visited the Amsterdam STI clinic. Online questioners, offered when obtaining the test results, measured the usability and acceptability of the service using 7 items each as operationalized by Davis [1998]. Usability refers to the perceived ease of use and the perceived usefulness of the service. Acceptability refers to the level of perceived concordance of the service with one’s personal and social norms.
Results: The online test service received 3555 were unique visitors during the 11 month pilot phase. In total the visitors completed 1406 intakes, 80% (1130/1406) were referred to the laboratories to get tested and 20% (276/1406) were directly referred to the STI clinic because they had symptoms. Of the men referred to the laboratories, 47% (532/1130) got tested. Of the tested men, 96% (509/532) obtained their test results online and 17% (84/500) had one or more positive test result compared to 15% (260/1701) at the STI clinic. All positive men showed-up for treatment.
Of the men who tested 49% (256/532) completed the usability and acceptability questionnaires. Mean scores for usability and acceptability (range 1-5) were 4.5 (SD=.57) and 4.0 (SD=.44), respectively. Of the tested men 28% never visited the STI clinic before and 91% report that the service lowers the threshold for testing. Of the men who tested up to 2012 6,5% (242/3681) self reported to be HIV positive. Of these men 28% (69/242) had an STI compared to 15% (569/3867) overall.
Conclusion: The Internet testing service scored well on usability and acceptability and compliance with the testing procedures and their follow-up advice were extremely high. Close to one third of the users never visited the STI clinic before. This suggests that we indeed managed to lowers the testing threshold for HIV & ST. By facilitating STI testing through the internet we also increases the curative capacity of the STI clinic by treating more men who tested positive without seeing those who tested negative . Therefore Testlab can serve as good additional option to the existing testing facilities.
Methods: Through a national sexual health website for MSM, mantotman.nl, men can arrange a complete test package for Chlamydia, Gonorrhea, Syphilis and HIV at an accredited testing lab. Results can be later obtained online and men found positive are referred to STI clinics for direct treatment. Data on usage of the service was collected for 11 months. To determine the efficacy of the test service we compared the rate of positive serology found in the online sample with a sample of MSM who visited the Amsterdam STI clinic. Online questioners, offered when obtaining the test results, measured the usability and acceptability of the service using 7 items each as operationalized by Davis [1998]. Usability refers to the perceived ease of use and the perceived usefulness of the service. Acceptability refers to the level of perceived concordance of the service with one’s personal and social norms.
Results: The online test service received 3555 were unique visitors during the 11 month pilot phase. In total the visitors completed 1406 intakes, 80% (1130/1406) were referred to the laboratories to get tested and 20% (276/1406) were directly referred to the STI clinic because they had symptoms. Of the men referred to the laboratories, 47% (532/1130) got tested. Of the tested men, 96% (509/532) obtained their test results online and 17% (84/500) had one or more positive test result compared to 15% (260/1701) at the STI clinic. All positive men showed-up for treatment.
Of the men who tested 49% (256/532) completed the usability and acceptability questionnaires. Mean scores for usability and acceptability (range 1-5) were 4.5 (SD=.57) and 4.0 (SD=.44), respectively. Of the tested men 28% never visited the STI clinic before and 91% report that the service lowers the threshold for testing. Of the men who tested up to 2012 6,5% (242/3681) self reported to be HIV positive. Of these men 28% (69/242) had an STI compared to 15% (569/3867) overall.
Conclusion: The Internet testing service scored well on usability and acceptability and compliance with the testing procedures and their follow-up advice were extremely high. Close to one third of the users never visited the STI clinic before. This suggests that we indeed managed to lowers the testing threshold for HIV & ST. By facilitating STI testing through the internet we also increases the curative capacity of the STI clinic by treating more men who tested positive without seeing those who tested negative . Therefore Testlab can serve as good additional option to the existing testing facilities.
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