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The STI outpatient clinic online: The use and efficacy of a full-scale STI & HIV testing applications online. Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E, Davidovich U Online Research and Prevention unit Amsterdam Public Health Service Research department.

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slide1

The STI outpatient clinic online:The use and efficacy of a full-scale STI & HIV testing applications online

Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E,

Davidovich U

Online Research and Prevention unit

Amsterdam Public Health Service

Research department

Aids conference 2010

content
Content
  • Introduction: mantotman project and Test Lab
  • Test Lab procedure
  • Research questions
  • Results
  • Conclusion
introduction mantotman project
Introduction:Mantotman Project

3

  • Goal of the website:

“one stop shop” for all the information and interventions on sexual health

  • Main features of the website:
    • MANcyclopedy; online encyclopedia on sexual health
    • Sekswijzer; internet-tailored personal advice on sexual health & safe sex
    • Test Lab: Online application to arrange STI&HIV testing

Cooperation of:

  • Public health services Amsterdam and Rotterdam
  • Schorer; homosexuality, health and well-being
introduction why online sti testing and test lab
Introduction: why online STI testing and Test Lab

General benefits of the internet

  • It increases the accessibility to services
  • It increases the availability of the service (24/7)
  • It offers user friendly environment & anonymity

Why Test Lab?

  • To stimulate MSM to get tested on a regular basis
  • To lower the threshold for STI and HIV testing
    • No physical examination
    • No referral needed
procedure test lab procedure
Procedure: Test Lab procedure
  • Participants visit the website for an intake
    • Referral selection: 1. test locations or 2. STI clinic (symptomatic or partner with STI)
    • Print referral letter (personal code)
  • Participants visits one of the diagnostic laboratory’s in the city
    • Collection of urine, blood, (self)-swabs (rectal, throat)
    • Anonymous and free (registration on personal code and nickname)
procedure test lab locations
Procedure: Test Lab locations

Amsterdam: 9 test locations Rotterdam: 9 test locations

6

procedure test lab procedure1
Procedure: Test Lab procedure

Participants visit the website for an intake

Selection: Referral to test locations or referral to the STI clinic (symptomatic or partner with STI)

Print referral letter (personal code)

Participants visits one of the diagnostic laboratory in the city

Collection of: urine, blood, (self)-swabs ( anal, throat)

Anonymous and free (registration on personal code and Nickname)

The lab results are sent to the STI clinic. Diagnosed by the medical doctor and the “diagnoses” are put online.

Participants obtain test their personal “diagnoses” online

“Diagnoses” 1) all tests are negative, 2)`your test failed 3) One ore more tests are positive

Man who tested positive visit the STI clinic for further examination and treatment.

7

procedure test packets
Procedure: Test Packets
  • Chlamydia: 1. urogenital (urine) 2. rectal (self-swab) NAAT
  • Gonorrhea:1. urogenital (urine ), 2. rectal (self-swab), 3. throat (swab) NAAT
  • Syphilis:anti-TP + => VDRL and FTA
  • HIV (opting-out):combo Antibody & Antigen test
research questions 1
Research questions: 1
  • What is the usage of Test Lab and what is the service’s feasibility

Usage:

    • Number of visits, visitors, referred to Test Lab locations or STI clinic, men tested

Feasibility:

    • Diagnoses put online, diagnoses viewed, time between the different steps in the Test Lab procedure and do positive men visit the STI clinic?
research questions 2
Research questions: 2
  • What is the efficacy of Test Lab in finding MSM with an STI or HIV infection

Efficacy:

    • % positives in Test Lab compared to % positives at the STI-clinic A’dam (positivity rate)
    • Data selection:
      • Test Lab: users from Amsterdam
      • STI-clinic Amsterdam: asymptomatic, same period, same STI/HIV tests
results
Results

Data collection:

  • 11 months, from February 2008 till January 2009

Demographics: (users of test Lab N= 532)

  • Age
    • Mean: 36 SD=11
  • Self reported HIV status
    • 55% I’m HIV Negative (N=259)
    • 9% I’m HIV Positive (N=45)
    • 36% I don’t know my status (N=189)
results usage
Results: Usage

16

Unique visitors

Visitors Amsterdam or Rotterdam

Intake completed

Referred to Test lab locations

Tested

Results put online

Results viewed online

Positives visiting STI Clinic

3555

60% (2121/3555)

66% (1406/2121)

80% (1130/1406)

47% (532/1130)

100% (532/532)

99% (530/532)

99% (83/84)

31% of the men who got tested never visited the STI clinic before

results feasibility
Results: feasibility

Time in days between the different steps in the procedure

Mean (days) Median (days)

  • Online intake => visit test location: 10 (SD = 16) 4
  • Visit test location => results online: 8 (SD = 5) 7
  • Results put online => results viewed: 1 (SD = 3) 0
results lab results
Results: Lab results

* Difference in total due to failed tests or opting out for HIV

results online diagnoses
Results: Online diagnoses

16% (84/532)

18% (59/334)

Multiple infections:

  • 71 clients - 1 infection
  • 10 clients - 2 infections
  • 3 clients - 3 infections
results hiv status and online diagnoses
Results: HIV status and online diagnoses

21

13.9% (41/295)

42.2% (19/45)

results efficacy test lab vs sti clinic
Results: Efficacy, Test Lab vs STI clinic

STI positivity rate:

  • Test Lab Amsterdam: 19% (59/317)
  • STI clinic Amsterdam: 15% (260/1701)
results overall test lab
Results: Overall test lab

23

New HIV diagnoses:

  • 1,3% (21/1631)

Usability and acceptability of the application

  • Abstract number: CDC0660

Electronic poster: on conference website

conclusion
Conclusion
  • The online procedure is feasible:
    • High % of referred get tested (49%)
    • 99% of results are obtained online
    • 99% of positive clients visited the STI clinic
  • The online procedure is efficient in selecting the right population
    • 16% one ore more positive test results
    • % of positive higher compared to STI clinic (not significant)
    • The service is used by a high risk HIV+ population
    • And 31% of users never visited the STI clinic before
acknowledgment
Acknowledgment

Funding:

  • The Aids fonds
  • The centre of infectious disease control

Special thanks:

  • Martijn van RooijenData management and analyses