Why home STI testing might (finally) be about to take off
As the COVID-19 pandemic has shown the feasibility of home testing, some public health experts and lawmakers have finally begun to encourage home testing for sexually transmitted infections, in hopes of curbing soaring infection rates. ‘IST.
CDC data for 2020 reflects this upward trend: cases of gonorrhea are up 42% from 2016, syphilis is up 52%, and congenital syphilis — syphilis passed on during pregnancy — is up 235%, with 2,148 cases and 149 stillbirths and infant deaths.
As the pandemic has shown the feasibility of home testing, some public health experts and lawmakers have finally begun to encourage home testing for sexually transmitted infections.
This all seems worse given that these numbers are likely an undercount — and the pandemic has redirected STI surveillance resources and reduced clinic visits, as Nature’s Carrie Arnold pointed out.
But home testing could help offset that, with new laws being passed to require home testing insurance coverage and new STI tests being approved.
“I think we’ve all become more comfortable with self-testing with COVID,” Natalie Cramer, of the National Alliance of State and Territory Directors on AIDS, told Nature. “It opened up both a need and a level of comfort that people have around him.”
New laws, new tests: California was the first state to pass a law requiring health insurers to cover home testing for STIs, which went into effect last January.
“This is the first law of its kind, and I would say it’s state-of-the-art,” said Stephanie Arnold Pang, senior director of policy and government relations for the National Coalition of STD Directors, at the Los Angeles Times. “We want to remove all the barriers that prevent someone from getting tested for STIs, and the direct cost is a huge factor.”
In April, the Colorado Department of Public Health (CDPH) began offering free STI self-testing kits, discreetly mailed to people’s homes. The state is suffering from the same increase in STIs as the nation, and officials hope the new program can break down another barrier to testing: stigma.
“Some would prefer to be tested at home confidentially, or may not have a medical home they could go to, and so we are seeing more and more opportunities for home testing,” said Eric France, doctor. -Chief of the CDPH, in Denver. Fox 31.
There is a suite of at-home tests already available, Nature reported. In 2012, the FDA finally approved a home HIV test (26 after the first home test has been developed). Syphilis self-tests, which use small drops of blood or swabs, arrived in the late 2010s.
Tests that cover a variety of STIs all at once are also coming.
Abbott has received the green light from the FDA for its new test, which looks for cervicitis, chlamydia, gonorrhea, trichomoniasis and urethritis using a single swab or urine samples. The versatility of the test could help give doctors a better picture of a patient’s health and develop the right treatments for them more quickly, Abbott’s Kathryn Becker told FierceBiotech. But it is currently only approved for specimens collected in clinical settings, even if the patient is the one collecting the specimen themselves.
Abbott plans to move to home testing next, said Becker, whose value has been proven in the pandemic.
“As we look to the future of testing, we will be focused on bringing that kind of convenience and discretion for STIs and other conditions,” Becker said.
The limits of home tests: While clearly helpful for patients, home testing has drawbacks.
Chief among them is that tests are only as effective as the specimens from which they are tested, specimens which must be properly collected and applied to the test medium.
Home results also may not become important data points for public health officials, University of Alabama at Birmingham gynecologist Shweta Patel told Nature. The onus is on the user not only to report their own results, but also to conduct their own contact tracing — something she says doesn’t always happen.
Testing samples collected at home in labs can increase their accuracy, but time is also a factor, as we’ve learned during the pandemic. Syphilis tests that send samples to a clinic or lab can have true negative and true positive rates of over 98% when used correctly, Nature reported, but can take weeks to return samples. results, which limits their effectiveness as public health tools.
Allowing individuals to know their own status could prove to be an important part of the answer.
The cost of the tests — which can range from $40 to over $100 — may be one of the reasons those already approved aren’t more popular (which California law seeks to address). Clinical tests also revealed discrepancies in results between different users and different test lots, Nature reported.
Yet with the rise of STIs, including superbugs like drug-resistant gonorrhea, empowering individuals to know their own status could prove to be an important part of the answer.
“We have children born in California with syphilis,” California State Senator Richard Pan, who drafted the STI testing law, told the LA Times.
“You’d think it died out in the Victorian era.”
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