Building Healthy Online Communities (BHOC), in partnership with Emory University and NASTAD, developed the National Home Test Kits program (known as “Take Me Home”) for state and local health departments to offer confidential HIV and STD testing delivered securely and discreetly directly to their constituents.
Why? 16% of MSM who use dating apps reported that they hadn’t tested in the past year. Furthermore, there is significant customer demand for home tests: 77% wanted apps to add this feature. Easy access to home tests was even more popular (83%) among those who had never tested¹. To reach individuals who are not testing consistently (or at all), home testing is a great alternative to no testing.
Coming Soon! Pilot starting March 2020
To make mailed HIV testing most efficient for public health, we created a three-pillar strategy:
1) Centralized system for HIV test kit ordering, distribution and results
A centralized HIV test kit-ordering, fulfillment and results system will be based on processes already being used by Emory and collaborating public health agencies. Public health agencies who opt in to using the system will choose the type and numbers of mailed tests, the duration of their participation, and the eligible populations they would like to target. They can also customize standard content on the system to align with their own campaigns and prevention/care resource information.
2) Partnerships with public health agencies to fund HIV test kits and system infrastructure
Users of geospatial social networking apps, like Grindr, will have ordering links embedded within HIV-related content of their apps. Public health agencies can also include the ordering links in their other health promotion efforts.
3) Partnerships with companies who engage with higher risk persons and can promote HIV testing to their clients/users.
There are multiple ways for delivering test results depending upon the testing modality chosen for the campaign. For example, results from laboratory-based testing with self-collected specimens can either be returned to clients using a secure self-service results portal or results can be accessed/sent to an authorized public health agency for return to clients. Self-testing results are returned by the clients using a results survey with automated completion reminders to clients. Clients positive test results, will be sent links to geo-targeted testing and care services. Public health organizations may also choose to provide specific information about services in their area. resources. Public health agencies also have a secure self-serve data dashboard and and may access all information on kit ordering, fulfillment and results.
Frequently Asked Questions
Has this been tried before? What’s the evidence that it works?
Virgina, 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% hadn’t tested in the previous year and 14% hadn’t ever tested; positivity rate: 0.3%
· Virginia: 29% hadn’t tested in the previous year and 21% hadn’t ever tested; positivity rate:1.3%
· Arizona: Positivity rate:1.2%.
BHOC is partnering with Emory University, which published a study called eSTAMP that demonstrates the success of home-based HIV self-testing (HIVST) with rapid diagnostic tests (RDTs).
The study evaluated the ability of 22 MSM to conduct two HIV RDTs, interpret sample images of test results, and collect a dried blood spot specimen. Internet recruitment of MSM for HIV self-test distribution by mail resulted in a high proportion of infections identified in the first three months and a consistently high proportion of infections identified among social network members during the 12-month study. [Read the full study]
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. Once individuals come in for confirmatory testing, they will be known to the jurisdiction’s HIV care and surveillance systems.
Once dried blood spot testing is rolled out, information about HIV-positive results will be available to the user through a client portal and to the department of health through a secure file.
What happens to those who are not eligible?
App users who click on promotional links will be provided a link to gettested.cdc.gov to find test sites near them.
What happen to individuals in from non-participating jurisdictions?
They are given information about testing sites near them, through the CDC-maintained database.
How does syphilis testing work?
For at home collection of syphilis samples, Molecular will provide a DBS card and microtainer (especially for those with 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 samples 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.