JMIR Publications

ABSTRACT

Background:

Digital sexually transmitted and blood-borne infection (STBBI) testing services are used to improve testing access, but might replicate existing social inequities. GetCheckedOnline is a web-based STBBI testing service that generates laboratory requisitions without the need to visit a healthcare provider in British Columbia (BC), Canada. Previous research has shown that it has improved access to testing. As part of the program's continuous evaluation, we examined awareness and use of the service in five urban, suburban, and rural communities where the program has expanded.

Objective:

To determine if social location is associated with differences in awareness and use of the service in five communities outside Vancouver, British Columbia.

Methods:

We conducted a cross-sectional survey recruiting (in-person, online) sexually active people 16+ years old in five communities where GetCheckedOnline is available. We examined differences in awareness and use by age, gender identity, sexual identity, race/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework.

Results:

Of 1,658 participants (63.8% in-person, 36.2% online), 35.3% were aware of GetCheckedOnline and 19.5% had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (38+ years: awareness odds ratio (OR) 0.23 [95% Confidence Interval: 0.17 – 0.32], use OR 0.19 [0.12 – 0.28]; <25 years: awareness OR 0.39 [0.28 – 0.53], use OR 0.28 [0.18 –0.41]). Awareness and use were also lower in the lowest income group compared to the highest (awareness OR 0.39 [0.24 – 0.65]), use OR 0.36 [0.20 – 0.65]). Awareness and use were higher among genderfluid, genderqueer and non-binary compared to men (awareness OR 2.27 [1.63 – 3.18], use OR 1.97 [1.36 – 2.84]), transgender compared to cisgender participants (awareness OR 2.17 [1.54 – 3.06], use OR 2.15 [0.46 – 3.13]), and non-heterosexual compared to heterosexual participants (awareness OR 2.37 [1.89 – 2.97], use OR 2.53 [1.91 – 3.38]). People of Colour had higher awareness and use versus white participants (awareness OR 1.74 [1.34 – 2.26], use OR 2.01 [1.48 – 2.72]). Indigenous participants had higher awareness than white participants (OR 1.65 [1.19 – 2.20]) but no difference in use, while women had similar awareness but lower use compared to men (OR 0.68 [0.50 – 0.92]).

Conclusions:

GetCheckedOnline is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.