Gilbert Mark, Haag Devon, Hottes Travis Salway, Bondyra Mark, Elliot Elizabeth, Chabot Cathy, Farrell Janine, Bonnell Amanda, Kopp Shannon, Andruschak John, Shoveller Jean, Ogilvie Gina
British Columbia Centre for Disease Control, Vancouver, BC, Canada.
JMIR Res Protoc. 2016 Sep 20;5(3):e186. doi: 10.2196/resprot.6293.
Testing for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one's health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access.
This paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).
From 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model.
GCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO's uptake, acceptability, and health system impacts is currently underway.
GCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.
性传播和血源感染（STBBI）检测是一项有效的公共卫生策略，可促进个人对自身健康的掌控并预防这些感染的传播。多种障碍阻碍了检测的可及性，包括对污名化的恐惧、医疗服务提供者对风险的认知不准确，以及诊所服务和基础设施的可及性降低。性传播感染（STI）率的同时上升以及对现有临床服务的需求增加，使得这一问题更加紧迫。基于网络的检测具有若干优势，可能减轻现有的临床压力并促进适当的检测可及性。
本文描述了一项新型基于网络的检测服务GetCheckedOnline（GCO）的规划、开发和可用性测试，该服务作为不列颠哥伦比亚省（BC）现有性健康服务中整合的一种补充检测选项。
2009年至2014年，我们组建了一个多学科团队来设计和开发GCO。我们开展了3项初步研究，以确定青少年、男男性行为者（MSM）和性传播感染诊所患者对基于网络检测的看法，并通过焦点小组征求性健康护理提供者的观点。我们根据省级和国家级指南制定了知情同意程序、风险评估问题和检测建议，并通过与临床和社区利益相关者的协商对这些进行了评估。我们还进行了一项初步的健康公平影响评估，其结果也为GCO项目模式提供了参考。最后，2011年4月至2012年12月，我们从25名参与者那里收集了关于GCO原型功能和可用性的定性数据，并将他们的建议纳入最终模型。
GCO于2014年秋季在不列颠哥伦比亚省温哥华的6个试点地点推出。该服务包括3个主要步骤：（1）创建账户、完成评估并打印实验室申请单，（2）在参与的实验室地点提供血液和尿液样本，（3）在互联网上或通过电话接收检测结果。在这个试点阶段，我们向大温哥华地区现有的性传播感染诊所患者和男男性行为者推广了GCO。目前正在对GCO 的采用情况、可接受性和卫生系统影响进行严格的混合方法评估。
GCO是加拿大首个与现有性健康服务整合的综合性基于网络的STBBI检测项目，有可能减轻现有临床服务的压力，并覆盖面临检测最大障碍的人群。我们的经验凸显了在医疗保健系统中开发和实施新型复杂电子健康干预措施的促进因素和挑战，并强调了考虑更广泛实施背景的重要性。
