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IntroductionGay, bisexual, and other men who have sex with men (MSM) in British Columbia (BC) have a high incidence of HIV/STI, with many reporting barriers to accessing testing. An online HIV/STI testing service, Get Checked Online(GCO), was launched in 2014 to reduce these barriers. In this study we examined reach and acceptability of GCO within the MSM community.MethodsWe surveyed MSM living in BC over 6 months in 2016. Participants were recruited at local pride events, bars, on the street, in sexual health clinics, through social media, and on gay hook-up apps and websites. Survey questions were analysed descriptively and included questions about the service itself, sexual health, technology use, and demographic characteristics.ResultsOf 1272 participants completing the survey, 78% identified as gay and 16% as bisexual, 73% identified as White, 52% reported being single, and 55% reported living in the city of Vancouver. 32% were aware of GCO, 13% had visited the website and 3% had tested through the service (10% among the 411 men aware of GCO). Among GCO-aware participants, 50% intended to test through the service in the future (vs. 47% among GCO-unaware), 51% reported talking about GCO with others and 22% knew someone who has used it. 46% reported that at times they would use GCO over their usual place of testing. The most common benefits reported by participants were testing without waiting for an appointment (50%), getting results online (46%), and saving time (38%). The most common drawbacks were not speaking with a doctor or nurse (39%), not being sure how the service works (26%), and worrying about the privacy of one’s online information (20%).ConclusionApproximately 2 years after GCO’s launch, a third of MSM in the region are aware of the service with 1 in 10 GCO-aware men testing through the service. Given high intention to use GCO, these findings highlight the importance of continuing promotion efforts to raise awareness of the service among MSM.

IntroductionPositive user experiences are key to trust and repeated use of online services (known as e-Loyalty). GetCheckedOnline (GCO) is an online testing service for HIV/STI where clients complete a risk assessment, print lab forms, submit specimens at a lab, and retrieve results online (if negative) or by phone. We surveyed GCO clients on their perceptions of using the service. MethodsWe invited first-time GCO users (who consented to be contacted for research) to complete an anonymous online survey 2 weeks following reporting of test results. Survey questions were analysed descriptively and included demographics, reason for test, and how participants heard about GCO. Satisfaction, convenience, ease of use, and e-Loyalty (intention to use again, recommend to others) were measured using 5-point Likert scales and collapsed (low to neutral vs high responses). ResultsBetween July 2015-Sept 2016, 23% of 1099 first-time GCO users consented to be contacted for research and 136/208 (65%) of users contacted agreed to participate in the survey. Participants had a median age of 33 years, 80% were white, 67% male, 43% straight, and 43% men who have sex with men. The most common testing reasons were: routine test (64%), risk event/exposure (44%) and new relationship (22%). Participants heard about GCO from clinics/health providers (38%), campaigns (26%), social media (18%), and friends or partners (13%). Almost all participants were satisfied with GCO overall (93%) and with their experience of receiving results (96%), 92% agreed GCO was convenient, 87% found GCO easy to use, and 83% rated the experience of submitting specimens as good or excellent. E-Loyalty was also high: 97% intended to use GCO again and 96% would recommend GCO to others. ConclusionWe found very high satisfaction with and loyalty to GCO among first-time users, indicating a successful service model from a client perspective. In addition to uptake and test outcomes, user experience is a key outcome for evaluation of online HIV/STI testing services.

IntroductionOnline HIV/STI testing is an alternative to in-clinic testing, but may lead to missed opportunities for education due to the lack of provider-delivered pre/post-test counselling. GetCheckedOnline(GCO) is an online testing service offered through an urban STI clinic in Vancouver. It was designed to include concepts typically conveyed during in-clinic HIV counselling sessions (e.g., window period, public health reporting). The aim of this study was to compare knowledge of key HIV test concepts between clients testing through GCO and in-clinic.MethodsGCO and clinic participants were concurrently recruited over 11 months. Participants were invited to complete an anonymous online survey 2 weeks after receipt of test results. Knowledge of key concepts related to HIV testing was measured using a 6-item true/false test previously developed through a modified Delphi process, cognitive testing and psychometric evaluation. Linear regression was used to assess the association between site (GCO vs. clinic) and overall test scores, after adjustment for age, education, immigration history, language, sexual orientation, and testing history.Results404 HIV-negative participants were included in the analysis (73 GCO, 331 in-clinic). HIV test knowledge scores averaged 0.4 points higher among GCO (mean score 4.5) than among clinic (4.1) testers (p=0.01). Following adjustment for relevant covariates, this difference decreased to 0.2 points (p=0.15). Likewise, there was no difference in mean HIV test knowledge scores among first-time testers (n=50; 3.7 GCO, 3.6 in-clinic; p=0.75).ConclusionPost-test knowledge of HIV test concepts addressed in standard pre-test counselling was high in both groups and not significantly different following adjustment. Our study suggests that equivalent education about core HIV testing concepts can be achieved through web-based HIV/STI testing, and illustrates the importance of designing services to intentionally address relevant educational messages covered in provider-delivered HIV test counselling.

IntroductionOnline STI testing programs are thought to overcome barriers posed by in-clinic testing, though uptake could reflect social gradients (e.g., technology access, higher education). To understand types of barriers mitigated by online STI testing we compared clients of a large STI clinic to clients of GetCheckedOnline(GCO).MethodsOur study was conducted in Vancouver after GCO was promoted to provincial STI clinic clients and men who have sex with men (MSM). Clinic and GCO clients were invited to an online survey 2 weeks after receiving test results. Survey questions included barriers/facilitators of testing at individual, provider, clinic and societal levels. We conducted bivariate comparisons between groups (significant results shown at p<0.01).ResultsGCO (n=87) were older than clinic clients (n=424; median 35 vs. 31 years) and a higher proportion were MSM (40.2% vs. 24.4. More GCO clients reported their reason for testing as routine (58.1% vs. 38.9%) and fewer for symptoms or STI contact (10.3% vs 33.5%). More GCO clients considered accessing online health resources important (76.1% vs 56.5%) but otherwise did not differ on technology skills/use. GCO clients were more likely to report delaying testing in the past year due to clinic distance (22.4% vs 9.7%), less likely to agree that clinic hours were convenient (58.2% vs 77.2%) or that making appointments was easy (49.4% vs. 65.4%), and more likely to report long wait times to see a health care provider (HCP) (47.6% vs 20.7%). GCO clients were more likely to be uncomfortable discussing their sexual history with HCP in general (15.5% vs 5.7%) and where they usually presented for health care (34.9% vs 20.6%), as well as reporting more fear of being judged by HCP (28.6% vs 15.4%).ConclusionOur study in Vancouver suggests that online testing services may effectively engage individuals with barriers to testing (i.e., clinic access, discomfort with HCP) with few social gradients in uptake. Further evaluation to verify these findings within different cities/populations is needed.

IntroductionMost research on the sexual health of gay, bisexual, and other men who have sex with men (MSM) relies upon convenience samples, which may not fully represent the MSM population. To investigate this form of selection bias, we concurrently sampled MSM from three distinct venue types, compared sociodemographic, behavioural, and STI testing characteristics across samples, and characterised the degree of overlap between them.MethodsMSM 18+ years of age from British Columbia, Canada completed an anonymous survey during July-December 2016. Participants were recruited from: mobile sex-seeking apps (n=662); a MSM-branded STI clinic (n=303); and in-person at the Vancouver Pride Festival (n=307). Cross-sample comparisons with >10% relative difference and p<0.05 are shown. Sample overlap was measured by self-reported use of other recruitment venue types.ResultsMSM recruited from apps included more bisexual men (24%) than those recruited from the clinic (9%) or from Pride (7%), while MSM recruited from the clinic included more East Asian and Latino men (14% and 13%, respectively, vs. 13% and 6% from Pride, and vs. 5% and 3% recruited from apps). More 18–29 year-olds were recruited from the clinic (47%, vs. 29% Pride, 16% apps). A larger proportion of MSM recruited from apps reported >10 sex partners in the past year (35%, vs. 28% clinic, 21% Pride). Finally, more clinic participants tested for STI/HIV in the past year (82%) as compared with participants recruited from apps (75%) or Pride (73%). When asked which other venues they frequented, 19% of the total sample reported using all 3 recruitment venue types, while 11% of Pride participants, 7% of apps participants, and 4% of clinic participants reported only using the recruitment venue where sampled.ConclusionWe found large differences between MSM sampled from apps, an STI clinic, and Pride, with 22% unlikely to be sampled if relying on a single venue type for recruitment. Our results underscore the importance of multiple sampling strategies in MSM research and provide specific cross-sample differences.

IntroductionGetCheckedOnline (GCO) is an online HIV/STI testing service where clients create an account, complete a risk assessment, print a lab form, submit specimens at a lab and get results online or by phone. From April-Sept 2015 the JustMakesSense (JMS) campaign aimed to increase awareness and use of GCO among gay and bisexual men (GBMSM) in Vancouver. JMS promoted GCO’s convenience and used multiple physical and online venues (social media, sex-seeking websites/apps, gay bars, events), with venue-specific codes to create accounts which we used to measure campaign impact. MethodsIndividuals were tracked from JMS website visits to GCO account creation and testing using venue-specific GCO access codes. Awareness of JMS and GCO was measured using a Pride survey (Aug 2015) and post-campaign perceptions of JMS and GCO gathered through key informant interviews and focus groups. ResultsOver 6 months, 18 273 views of the JMS campaign page led to 659 (4%) visits of the GCO website. 177 visitors created GCO accounts and by Dec 2015, 43 (24%) tested at least once (none positive). 58% of GCO accounts/52% of tests were from ads on sex-seeking websites/apps (vs. 1%/0% from social media, 12%/9% from physical venues, and 29%/39% source unknown). 25% of 114 GBMSM surveyed were aware of JMS and GCO. Interviews/focus groups with 7 participants suggested GCO may not have been perceived as convenient given existing accessible, culturally appropriate HIV/STI testing services for GBMSM in Vancouver, and that GCO may better suit men living outside urban Vancouver or with privacy concerns that make visiting gay-branded testing services less likely. ConclusionOur novel use of unique tracking codes permitted detailed per-venue evaluation of the JMS campaign; greatest uptake was from sex-seeking website/app ads vs. other venues. While JMS views were high and 1 in 4 men were aware of GCO, GCO use was low possibly owing to the availability of relatively convenient in-clinic testing services in the city. Promotion outside Vancouver and of the privacy of GCO may increase uptake among GBMSM.

IntroductionYouth and men who have sex with men (MSM) are two priority populations with regards to sexual risk, HIV/STI prevalence, and barriers to sexual healthcare. In 2014, an online HIV/STI testing service called GetCheckedOnline(GCO) was implemented in Vancouver, Canada to address several barriers to testing. We investigated the acceptability and perceptions of GCO among youth and MSM, and identified how various social positions related to age, sexual identity, and geography affected preferences for online versus in-person testing. MethodsWe conducted in-depth, semi-structured interviews with 12 youth (ages 23–29) and 19 MSM (ages 30–71) who had used GCO at least once. Interviews were analysed for emergent themes and participants’ sociodemographic data were collected via a brief questionnaire.ResultsYouth participants identified predominantly as male (92%), Caucasian (58%), and heterosexual (50%). MSM participants identified as male (100%); Caucasian (84%); and gay, bisexual, or pansexual (68%, 26%, 5%). Both populations were motivated to use online testing for: convenience, not having to wait to get tested at a clinic, increased privacy/anonymity, and avoiding judgment from healthcare providers. Additionally, youth perceived online testing as modern and “the future.” MSM participants perceived GCO as providing increased control over tests ordered and decreased anxiety due to receiving results faster. For three rurally-based MSM, GCO offered a way to test discreetly without identifying one’s sexual orientation to a healthcare provider. Even among participants who reported routinely accessing face-to-face health services (including for health concerns other than STIs), GCO was described by most interviewees as advantageous in terms of convenience and privacy. Overall, 83% of youth and 84% of MSM said they would use GCO again.ConclusionGCO was regarded as an acceptable and preferred option for accessing testing. Convenience was the most common reason for wanting to test online, although this varied somewhat by age, sexual orientation, and geography.

IntroductionIn Sept 2014, the BC Centre for Disease Control (BCCDC) launched GetCheckedOnline (GCO), an online testing service for STI/HIV which is integrated with clinical and public health services and developed to reduce testing barriers. Based on a successful pilot in urban Vancouver (BC’s largest city) and alignment with regional health authority testing priorities, GCO was expanded to five other urban, suburban and rural communities across BC in Feb 2016. Here we examine differences in GCO uptake between Vancouver and expansion sites from the first year of scale-up in British Columbia (BC). MethodsWe used routinely collected GCO program data in combination with BC Public Health Laboratory testing data to describe differences between GCO clients in Vancouver and expansion sites. We compared demographic characteristics and testing history as well as key program measures including service uptake (percent creating a GCO account who submitted specimens) and positivity rates (percent positive of specimens submitted). ResultsBetween Feb-Dec 2016, of 2397 clients creating accounts, 1297 (54%) submitted specimens; uptake was slightly lower in expansion sites (577 specimens, 51%) vs. Vancouver (720, 57%; p=0.001), with comparable positivity rates (6% vs. 5%; p=0.77). Compared to Vancouver, GCO clients in expansion sites were more likely to be younger (20–24 years of age) (20% vs. 13%) and symptomatic (20% vs. 14%), and less likely to be men who have sex with men (22% vs. 42%; p≤0.001 for all). GCO clients in expansion sites were more likely to be testing for the first time for both HIV (22% vs. 9%) and STI (16% vs. 9%; p<0.001).ConclusionScale-up of GCO to five smaller urban, suburban and rural communities across BC demonstrated differences in uptake and populations reached, including greater engagement of individuals not previously tested. Our study highlights the importance of differing regional contexts on the impact of online testing services and the need for their evaluation during scale-up.