TakeMeHome – a new free HIV home testing program
Building Healthy Online Communities (BHOC), in partnership with Emory University and NASTAD, developed the National Home Test Kits program for state and local health departments to offer confidential HIV and STD testing delivered securely and discreetly directly to their constituents.
During our pilot phase, TakeMeHome will target MSM who use dating apps. However, we anticipate that this program will be expanded to target other populations in the future.
The 2019 American Men’s Internet Survey found that 22% of MSM who use dating apps reported that they had NEVER tested for HIV.
We also know there is significant customer demand for home tests: 77% of survey respondents wanted apps to add this feature. Easy access to home tests was even more popular (83%) among those who had never tested.
To reach individuals who are not testing consistently (or at all), and may not be accessing current testing options, home testing is a great way to reach those who aren’t getting tested.
To make mailed HIV testing most efficient for public health, we created the following strategy:
1) Centralized system for HIV test kit ordering and distribution
We have developed a centralized HIV test kit-ordering and fulfillment system based on programs already being implemented by Emory and collaborating public health agencies. Public health agencies who opt in to using the system can choose the type and numbers of mailed tests, the duration of their participation, and the eligible populations they would like to target. Through this system, public health agencies can purchase kits via their NASTAD membership and can request increases to their purchases as needed. (Expansion to non-NASTAD members is now available.) They can also customize content on the platform to align with their own campaigns and prevention/care resource information, and incorporate that information into the delivery system.
2) Testing options
For now, users will be sent an HIV oral rapid in-home test, with detailed instructions and information about confirmatory testing and HIV and STI prevention and care resources. In July 2020, we will expand the options to include STI testing swabs and HIV dried blood spot confirmatory testing, which users can send to a laboratory in the postage-paid return packet that will be included.
Dating apps will promote this opportunity through messaging and advertisements. New jurisdictions will get a minimum of 2 messages per month for the first 4 months of participation. Users of geospatial social networking apps, like Grindr, can order by clicking on a link embedded within HIV-related content of their apps. Public health agencies can also include the ordering links in their other health promotion materials.
4) Results delivery
For now, users will get their results at home using an OraQuick self-administered swab. In the near future, we will also offer laboratory testing.
When STI testing is available and users select it, they will be able to access results of laboratory-based testing of self-collected specimens using a secure self-service results portal. Users with positive test results will be sent links to geo-targeted testing and care services and all users will receive basic information about STI testing, PrEP, condoms, and U=U. Public health organizations may also choose to provide specific information about services in their area. All positive results for tests with required reporting will be automatically reported to the health department. Public health agencies will have a secure self-serve data dashboard and may access all information on kit ordering, fulfillment and results.
Costs of participation:
The cost is calculated based on the number of tests purchased. This cost includes promotion through the apps (though jurisdictions may also choose to supplement this), test kits, delivery/fulfillment, and participant survey data.
The current cost is $46 per kit, so if your jurisdiction aims to send out 100 kits, plan to budget $4600.
We continue to work with manufacturers to get the cost reduced.
Utilizing HIV Self-Testing to End the HIV Epidemic
Frequently Asked Questions
Has this been tried before? What’s the evidence that it works?
Virginia, Arizona, and New York City have piloted the delivery of home test kits and have found that this process enabled them to reach individuals who hadn’t tested recently. In some cases, they have succeeded in reaching a higher positivity rate than traditional testing strategies.
- New York City: 28% of testers hadn’t tested in the previous year and 14% hadn’t ever tested. They reported a positivity rate of 0.3%
- Virginia: 29% of testers hadn’t tested in the previous year and 21% hadn’t ever tested. They reported a positivity rate of 1.3%; 88% of new positives were linked to care within 30 days.
- Arizona reported a positivity rate of 1.2%.
For more information about home testing from the CDC, including study results from other home testing programs, click here.
Who are these tests targeting?
For the time being, the national resource will focus on the 30% of all MSM who haven’t tested for HIV in at least one year. Promotion will happen predominantly through gay dating apps. Health departments will soon have the opportunity to promote this program to whichever populations they choose and will have greater flexibility to choose their eligibility criteria. We are looking to expand our target populations once we have gotten the program fully up and running.
What happens with linkage to care and support for individuals who test positive?
Individuals will get information in their test kits about what to do in the case of a positive result. This will include how to obtain a confirmatory test at a local clinic, and the number of OraSure’s hotline if needed. (Some states or jurisdictions may already have or want to create a hotline for this purpose.)
Following a preliminary positive result at home, when an individual comes in for confirmatory testing, they will be known to the jurisdiction’s HIV care and surveillance systems.
Once dried blood spot testing is implemented, users can access their results through a client portal. The health department will also receive positive results through a secure file.
What happens to those who are not eligible?
If a user is ineligible, either because he does not live in a participating jurisdiction or because he has been tested within the past 12 months, TakeMeHome will link them to gettested.cdc.gov to find test sites near them. The site also has information regarding prevention strategies.
What happens to individuals from non-participating jurisdictions?
They are given information about testing sites near them, through the CDC-maintained database.
How does syphilis testing work?
TakeMeHome is expanding to offer STI self-collection. We estimate launching this in July, 2020.
For at home collection of syphilis samples, Molecular will provide a DBS card and microtainer. (especially for those with a known history of syphilis).
The DBS sample is first tested using an EIA assay for the qualitative detection of IgG antibodies to T. pallidum.
If negative, then the sample is reported as “not detected.”
If positive, then the sample is repeated in duplicate using the EIA assay. If at least one of the duplicate repeats are positive, the microtainer sample reflexes to RPR qualitative (POS or NEG).
If the RPR is positive, then a full titer is performed.
How is this program run logistically? Who houses the testing kits and fulfils orders?
TakeMeHome and its delivery subcontractor takes care of all that. It is handled by a company that we have a contract with. All of these services are included in the cost. Each health department orders the number of kits they want; TakeMeHome takes care of the rest, as well as promotion. Additionally, health departments may modify the numbers of tests they order during a given time period.
Can PS18-1802 HIV grant funding or other funds be used to participate in the program?
You can use PS18-1802 funds or other funds for this program. Payment is made through NASTAD.
What data will be made available to participating health departments?
We will make the following data available:
- # of people from each jurisdiction who visited to the TakeMeHome website
- Client-level detail for each kits sent out, including:
- Mailing address, including zip code
- # of kits ordered
- Sex at Birth
- Time since last HIV test
- # of kits sent out
- Follow-up client surveys include the following
- Gender identity
- Number of anal and/or vaginal sex partners
- Transmission category
- Where their most recent HIV test was
- Whether they took the test
- Test result information
- Linkage information
- Access to PrEP
- Access to STI testing
- Feedback about their experience
We are currently building into the system the following additional metrics to include the following:
- # of ad impressions, clicks, and click-through rates
- # of views of those sites provided to users and average session durations
- # of people who start to fill out the eligibility survey
- # determined to be eligible, by jurisdiction
- # STI or HIV DBS results returned for lab-based testing
- % of lab-based testing samples returned properly
- positivity rate (# new cases identified), by jurisdiction
- linkage to care among new positives
- # of people who complete the post-test survey
- completion rate for post-test survey
What is in place in regards to data security and HIPAA protections?
We have worked closely with our Compliance Officer, IT, and legal teams to ensure the highest quality data security and HIPAA practices. Our lab testing partner, MTL, has a secure lab portal for STI results (when this feature becomes available) and they ensure HIPAA protections are in place for all of their services. We have a signed BAA in place with MTL that covers all participating jurisdictions. Each participating jurisdiction will get a copy of this BAA for their records.
Can an individual order more than one test?
Yes, during our pilot phase, jurisdictions can opt between allowing participants to order just one test for themselves or two. In the future, we are open to expanding this more widely, based on requests from jurisdictions.
Evidence has pointed to increased positivity rates among individuals who give test kits to their partners and peers.
How will our surveillance know about new positive tests?
It’s helpful to remember that at any point, anyone in your jurisdiction can walk into a Walgreens and purchase this test over the counter or order one online. The only difference is that your state is now supporting MSM who haven’t tested recently to get easier access to these tests. Your surveillance team will know about these positives as individuals come in for confirmatory testing.
What’s the process and options for distributing State-specific messages or information about State/local resources in association with the test kits?
We are building the platform with that in mind. We will have multiple opportunities for participating jurisdictions to put in their own campaign messages.
Pilot starting March 31, 2020
Contact firstname.lastname@example.org to learn more