Home-based STI screening breaks down barriers, but many programs aren’t youth-friendly



Sao S, et al. Abstract 117. Presented at: ACOG Annual Clinical and Scientific Meeting; May 6-8, 2022; San Diego.

Disclosures: Sao does not report any relevant financial information.

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SAN DIEGO — Results of a scoping review showed that home testing for sexually transmitted infections addresses significant barriers that often prevent young people from seeking care, but few programs are youth-friendly.

Self-testing for STIs has become increasingly popular during the pandemic with the closure of testing clinics, according to Saumya Sao, BA, clinician scientist in the department of gynecology and obstetrics at the Johns Hopkins School of Medicine. Additionally, the CDC recently reported that STIs have continued to rise during the pandemic, making testing and linking to care even more important.

Among several barriers to testing youth for STIs are privacy and confidentiality, which makes home testing a more attractive option. Source: Adobe Stock

“Self-collected, mail-out STI testing eliminates many barriers to STI testing that are specific to young people, simply because of its innate nature,” Sao told Healio.

For example, she says, “it solves the transportation problem,” as well as privacy and the need for confidentiality.

Saumya Sao, BA

Saumya Sao

Jenell Coleman Fennell, MD, MPH

Jenell Coleman Fennel

Six months ago, Sao and Jenell Coleman Fennell, MD, MPH — the director of the division of gynecological specialties and associate professor of obstetrics and gynecology at Johns Hopkins — has launched its own STI screening platform called The Violet Project, which is aimed specifically at teenagers.

“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 his colleagues reviewed more than a dozen programs that offer self-collected, mail-in STI tests.

“The categories we looked at were specific to the unique needs of young people, ages 13 to 24,” she said. Categories included cost, whether the platform connected the user to a clinician and whether there were additional costs because of this, whether the packaging was discreet, and whether there were age restrictions.

The researchers assigned a score to each program, depending on whether or not it was suitable for young people.

“Almost all programs are,” Sao said, “but they can definitely improve access to STI testing for an older population.”

The results also showed that the disbursements were “higher”, according to Sao. For example, only three programs offered free testing, and the others charged between $45 and about $180 to test for chlamydia and gonorrhea. Tests became even more expensive if they covered other STIs and HIV. Few programs connected users to a clinician, and even fewer did so for free. Additionally, many programs did not show what the test packaging looked like on their websites, potentially discouraging young people from applying for them, and most had age restrictions.

“We took all of these shortcomings into consideration when we created The Violet Project’s test platform,” Sao said.

Although several programs have failed to overcome some significant barriers to STI testing, such as cost and linkage to care, Sao stressed that any increase in access to health care is a good thing.

“The STI self-collection test is ideal for people who may be particularly marginalized or feel stigmatized in a health care setting, as they can do so in privacy,” she said. “Self-collection STI testing can also be encouraged by clinicians to ensure that people who test positive at a clinic are compliant with retesting after 3 months. It also allows for great flexibility for people who can’t miss work or find child care for a clinic appointment. However, we felt it was important to create a new platform specifically geared towards young people, simply because this demographic has unique needs. So the increased access with all the platforms we found is great, but we felt the need to expand that access to something specific for young people.

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