Abstract #97  -  Testing thresholds to zero: usage, usability and acceptability of online testing for HIV, STI, and HEP C
Authors:   Presenting Author:   Dr Udi Davidovich - Amsterdam Health Service
Additional Authors:  Drs Rik Koekenbier, Drs  Freke Zuure,
Aim: We wanted to use the internet to lower the threshold for STI and Hepatitis C (HCV) testing by enabling users to initiate anonymous and free testing without the mediation of a doctor or visit to STI clinics. We developed two separate online testing services. The first, in www.mantotman.nl, targeted exclusively men who have sex with men (MSM), offered an STI testing package (HIV, Syphilis, Gonorrhea & Chlamydia). The second, www.heptest.nl, offered a testing procedure for HCV – an emerging STI among HIV+ MSM but targeted to a mixed population of risk groups. In both services, users went through short online questionnaires to establish eligibility for testing and could then download a referral letter for anonymous tests which were performed at GP labs. Tests results could be later obtained online, using a personal log-in code. If tested positive, a treatment trajectory (for STI) or a referral to specialist (for HCV) was offered. In this paper we present the evaluation of these services for usage, usability, acceptability and efficacy in attracting high-risk populations.
Method / Issue: In both online projects we asked users to fill out an online questionnaire on usability and acceptability using measures by Davis [1998]. Usability refers to the perceived ease of use and the perceived usefulness of the service, and acceptability refers to the level of perceived concordance of the service with one’s personal and social norms.
Results / Comments: The STI testing site received in a period of 11 months 3555 unique visitors of which 1406 completed the intakes and 1130 could be referred for testing. Of those, 47% (532/1130) got tested. 96% (509/532) obtained their test results online and 17% (84/500) had one or more positive test result. In Amsterdam, 19% (59/317) tested positive compared to 15% (260/1701) at the STI clinic. All positive men showed-up for treatment. Of the tested men, 49% (256/532) completed the usability and acceptability questionnaires. Mean scores for usability and acceptability (range 1-5) were 4.5 (SD=.57) and 3.9 (SD=.44), respectively. During 19 months, heptest.nl attracted 20,920 visitors of whom 9,712 completed the risk assessment questionnaire. A blood test was offered to those at risk in the project’s pilot regions (n=1,509) and 28% (421/1,509) eventually got tested. HCV antibodies were detected in 4.5% (19/421). The HCV prevalence among testers was 7-29 times the estimated prevalence in the general population (0.1-0.4%). 22% (2,154/9,712) completed the questionnaire on usability and acceptability. Mean scores (range 1-5) on usability of the risk questionnaire and the online testing were 4.8 (SD=.4) and 4.4 (SD=.7) respectively. Scores on acceptance of online vs. (a hypothetical) pencil & paper risk assessment were 4.6 (SD=.6) and 2.9 (SD=1.1) respectively.
Discussion: Internet-mediated STI and HCV testing were effective in reaching high-risk populations and usability and acceptability scored well. Compliance with the testing procedures and their follow-up advice were extremely high. As internet-mediated testing is at low cost (e.g., no GP or nurse staff if tested negative) our approach could prove cost-effective next to being low-threshold.
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