How Home Test Kits Are Expanding Patient Access to STI Testing

For a public health campaign to work, it’s going to have to meet people where they’re at. That much is apparent for Joshua O’Neal, the director of the sexual health program for the Fulton County Board of Health in Georgia, which recently launched a new home test kit program to expand patient access to STI testing and sexual health.

The program, launched in partnership with at-home testing and diagnostics company Ash Wellness, lets anyone in Fulton County, which includes the Atlanta area, request an at-home test for STIs that may affect them based on their self-reported sexual preferences.

According to O’Neal, just having this option is a great step forward in a place like Atlanta.

“First and foremost, the South isn't necessarily known for heavily funding sexual health issues of any type, especially sexual health screenings or education prevention measures,” O’Neal told PatientEngagementHIT in an interview. “This program is just to ensure that that access is available for services like this because they're limited.”

It’s more important than ever before to promote access to sexual health and STI testing and prevention, he added. Two years of a global pandemic stymied patient access to preventive care and testing, including STI testing. A recent Centers for Disease Control & Prevention report showed a 17 percent dip in HIV diagnoses in 2020, not because there was less disease spread, but because there was less access to HIV—and other STI—testing.

“People weren't out and about,” O’Neal noted. “People weren't in the community. People didn't have access to services, they were limited. And so, the amount of tests that happened over the last couple of years went down severely, and now we have a lot of catching up to do.”

That’s where the Testing My Way program, launched as part of the FCBOH’s #StopHIVATL program, comes into play. Folks can log onto an online portal or visit one of FCBOH’s community-based organizations (CBOs) to request a test, provide some information about how they have sex, and receive a tailored home test kit that provides a comprehensive sexual health screening.

These are at-home kits, meaning they are sent to peoples’ homes and they perform the tests themselves, O’Neal emphasized. While not exactly commonplace back in 2018, the healthcare consumer landscape is primed for a system that works like this, after years of home COVID-19 testing and other home-based health, like telehealth.

“COVID is the catalyst for a lot of change in the ways that we show up and support communities, including this one,” O’Neal posited. “We are used to testing. Biomedical interventions are a thing that we're accustomed to now, especially at home, that I think clinicians give more freedom for things to happen at home, like telehealth and medicine, which is something that wasn't very common before.”

The key is to get the community messaging right, something O’Neal acknowledged is not always easy. Access to free and comprehensive STI testing should be liberating, O’Neal stressed, but in a place like Georgia where he said sexual health education has not always been well-funded, it’s easy for public health messaging to instill fear instead.

“Many people assume that they're at risk for a lot of these sexual health disparities when in fact many people are not,” O’Neal pointed out. “So, if we blasted out to communities at large, I think that there's going to be this rush to be like, ‘I’ve got to get on top of this,’ despite the fact that that might not actually be a concern. How do we make sure that people who experience sexual health disparities are the ones that we center in the ways that we reach out to folks?”

For O’Neal, that means reaching out to people where they are using language that they know and understand. As part of this home STI testing rollout, FCBOH plans on tapping community leaders who are trusted by marginalized communities.

And, importantly, messaging and marketing need to happen where people will actually see it.

“I want non-traditional approaches to doing this,” O’Neal said. “That is why this isn't set on the Fulton County Board of Health website, because there's no traffic there. Why do people go to the Fulton County Board of Health website? But the #StopHIVATL website—which is about activism, which is about messaging and getting health issues—that is where we're pushing it out.”

O’Neal also imagines a lot of the messaging will happen organically and by word of mouth, the way he saw word spread about PrEP, or pre-exposure prophylaxis, a few years ago.

“You hear about PrEP, you see it in messaging,” he recalled. “But the reality is it's not until you're starting to have sex with people who are on it, or your friends are telling you they're on it. And they're having a good experience and the sexual liberation they're experiencing with it that you're like, ‘oh, I can get it out of that. I could do that.’ And so that's where I feel we'll have the most traction.”

Messaging is only half the patient access battle, though. It is critical that these home test kits are affordable (O’Neal said they are free of cost to anyone who wants one, regardless of insurance status) and easy enough to use for a healthcare consumer.

That level of accessibility is really important for building trust between traditionally marginalized folks and healthcare entities; if an individual hears about a program but can’t actually use it, it could discourage care-seeking down the line.

Even the home-based nature of the STI testing kits is important, O’Neal remarked. You don’t have to give up a workday to get a test. You don’t have to be seen walking into a sexual health clinic or an HIV organization, which can be a barrier for a lot of people. You don’t need to obtain an appointment, and you don’t have to search for a care site that is convenient.

And, importantly, you don’t have to place your trust in a healthcare professional who might not understand or have the knowledge needed to deliver care to someone in the LGBTQ+ community, which research has confirmed can be a huge issue

Making these tests available free of charge and insurance status to all people, and protecting undocumented folks who want access to the home tests, was a key first step in building accessibility. Next, O’Neal said FCBOH is looking at language accessibility.

“The platform currently is only in English, so that's not accessible,” he posited. “To complement that, we are next week going to do recordings of how do you swab yourself, how do you process these specimens in both English and Spanish.”

Language accessibility includes not just language preference, but also patient health literacy and using terms the users understand, are accustomed to, and that makes them feel comfortable. That isn’t always the most “clinical” language choice, O’Neal said, drawing from previous experience launching a similar program in California.

“It’s about being real and honest and using language that people use,” O’Neal explained.

That philosophy aligns with how O’Neal believes FCBOH can realign how it talks about sexual health. The agency is looking at how people realistically want to engage with their sexual health and what services they truly need, and then FCBOH is reconsidering how FCBOH can allocate its resources to give the public the tools they need to feel liberated and take care of themselves.

“It's about refocusing and centering how we approach this work from one is like, let's bring you in and give you all the information and the tools, access to the tools you need. And you can pick what works for you,” O’Neal concluded.