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Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E, Davidovich U

The STI outpatient clinic online: The use and efficacy of a full-scale STI & HIV testing applications online. Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E, Davidovich U Online Research and Prevention unit Amsterdam Public Health Service Research department.

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Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E, Davidovich U

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  1. The STI outpatient clinic online:The use and efficacy of a full-scale STI & HIV testing applications online Rik Koekenbier, Fennema H, Leent van E, Zuilhof W, Veen van E, Davidovich U Online Research and Prevention unit Amsterdam Public Health Service Research department Aids conference 2010

  2. Content • Introduction: mantotman project and Test Lab • Test Lab procedure • Research questions • Results • Conclusion

  3. Introduction:Mantotman Project 3 • Goal of the website: “one stop shop” for all the information and interventions on sexual health • Main features of the website: • MANcyclopedy; online encyclopedia on sexual health • Sekswijzer; internet-tailored personal advice on sexual health & safe sex • Test Lab: Online application to arrange STI&HIV testing Cooperation of: • Public health services Amsterdam and Rotterdam • Schorer; homosexuality, health and well-being

  4. Introduction: why online STI testing and Test Lab General benefits of the internet • It increases the accessibility to services • It increases the availability of the service (24/7) • It offers user friendly environment & anonymity Why Test Lab? • To stimulate MSM to get tested on a regular basis • To lower the threshold for STI and HIV testing • No physical examination • No referral needed

  5. Procedure: Test Lab procedure • Participants visit the website for an intake • Referral selection: 1. test locations or 2. STI clinic (symptomatic or partner with STI) • Print referral letter (personal code) • Participants visits one of the diagnostic laboratory’s in the city • Collection of urine, blood, (self)-swabs (rectal, throat) • Anonymous and free (registration on personal code and nickname)

  6. Procedure: Test Lab locations Amsterdam: 9 test locations Rotterdam: 9 test locations 6

  7. Procedure: Test Lab procedure Participants visit the website for an intake Selection: Referral to test locations or referral to the STI clinic (symptomatic or partner with STI) Print referral letter (personal code) Participants visits one of the diagnostic laboratory in the city Collection of: urine, blood, (self)-swabs ( anal, throat) Anonymous and free (registration on personal code and Nickname) The lab results are sent to the STI clinic. Diagnosed by the medical doctor and the “diagnoses” are put online. Participants obtain test their personal “diagnoses” online “Diagnoses” 1) all tests are negative, 2)`your test failed 3) One ore more tests are positive Man who tested positive visit the STI clinic for further examination and treatment. 7

  8. Procedure: Test Packets • Chlamydia: 1. urogenital (urine) 2. rectal (self-swab) NAAT • Gonorrhea:1. urogenital (urine ), 2. rectal (self-swab), 3. throat (swab) NAAT • Syphilis:anti-TP + => VDRL and FTA • HIV (opting-out):combo Antibody & Antigen test

  9. Procedure: referral letter

  10. Procedure: Back office

  11. Soa*Hiv Procedure: Email

  12. Soa*Hiv Procedure: Results online

  13. Research questions: 1 • What is the usage of Test Lab and what is the service’s feasibility Usage: • Number of visits, visitors, referred to Test Lab locations or STI clinic, men tested Feasibility: • Diagnoses put online, diagnoses viewed, time between the different steps in the Test Lab procedure and do positive men visit the STI clinic?

  14. Research questions: 2 • What is the efficacy of Test Lab in finding MSM with an STI or HIV infection Efficacy: • % positives in Test Lab compared to % positives at the STI-clinic A’dam (positivity rate) • Data selection: • Test Lab: users from Amsterdam • STI-clinic Amsterdam: asymptomatic, same period, same STI/HIV tests

  15. Results Data collection: • 11 months, from February 2008 till January 2009 Demographics: (users of test Lab N= 532) • Age • Mean: 36 SD=11 • Self reported HIV status • 55% I’m HIV Negative (N=259) • 9% I’m HIV Positive (N=45) • 36% I don’t know my status (N=189)

  16. Results: Usage 16 Unique visitors Visitors Amsterdam or Rotterdam Intake completed Referred to Test lab locations Tested Results put online Results viewed online Positives visiting STI Clinic 3555 60% (2121/3555) 66% (1406/2121) 80% (1130/1406) 47% (532/1130) 100% (532/532) 99% (530/532) 99% (83/84) 31% of the men who got tested never visited the STI clinic before

  17. Results: Increase of use

  18. Results: feasibility Time in days between the different steps in the procedure Mean (days) Median (days) • Online intake => visit test location: 10 (SD = 16) 4 • Visit test location => results online: 8 (SD = 5) 7 • Results put online => results viewed: 1 (SD = 3) 0

  19. Results: Lab results * Difference in total due to failed tests or opting out for HIV

  20. Results: Online diagnoses 16% (84/532) 18% (59/334) Multiple infections: • 71 clients - 1 infection • 10 clients - 2 infections • 3 clients - 3 infections

  21. Results: HIV status and online diagnoses 21 13.9% (41/295) 42.2% (19/45)

  22. Results: Efficacy, Test Lab vs STI clinic STI positivity rate: • Test Lab Amsterdam: 19% (59/317) • STI clinic Amsterdam: 15% (260/1701)

  23. Results: Overall test lab 23 New HIV diagnoses: • 1,3% (21/1631) Usability and acceptability of the application • Abstract number: CDC0660 Electronic poster: on conference website

  24. Conclusion • The online procedure is feasible: • High % of referred get tested (49%) • 99% of results are obtained online • 99% of positive clients visited the STI clinic • The online procedure is efficient in selecting the right population • 16% one ore more positive test results • % of positive higher compared to STI clinic (not significant) • The service is used by a high risk HIV+ population • And 31% of users never visited the STI clinic before

  25. Acknowledgment Funding: • The Aids fonds • The centre of infectious disease control Special thanks: • Martijn van RooijenData management and analyses

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