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Post-test comparison of HIV test knowledge and changes in sexual risk behaviour between clients accessing HIV testing online versus in-clinic
  1. Travis Salway1,2,
  2. Kimberly Thomson1,2,
  3. Darlene Taylor3,
  4. Devon Haag1,
  5. Elizabeth Elliot4,
  6. Tom Wong5,
  7. Christopher K Fairley6,
  8. Troy Grennan1,7,
  9. Jean Shoveller2,
  10. Gina Ogilvie1,2,
  11. Mark Gilbert1,2
  1. 1 Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
  2. 2 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 School of Nursing, University of British Columbia, Okanagan, Kelowna, British Columbia, Canada
  4. 4 College of Registered Nurses of British Columbia, Vancouver, British Columbia, Canada
  5. 5 Indigenous Services Canada, Ottawa, Ontario, Canada
  6. 6 Central Clinical School, Monash University, Melbourne, Victoria, Australia
  7. 7 Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Mark Gilbert, BC Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada; mark.gilbert{at}


Objective Internet-based HIV testing offers the potential to address privacy-related barriers to testing and increase frequency of testing but may result in missed opportunities related to sexual health education and prevention that typically occur in face-to-face encounters. In this study, we assessed the HIV test knowledge and sexual risk behaviour of clients testing for HIV through GetCheckedOnline, an internet-based sexually transmitted and bloodborne infection testing platform inclusive of HIV testing, in comparison to clients testing through a large sexual health clinic.

Methods We concurrently recruited GetCheckedOnline clients and clinic clients from Vancouver, Canada, over the course of a 10-month period during 2015–2016. Participants completed baseline and 3-month questionnaires, anonymous and online. A six-item score was used to estimate knowledge of HIV test concepts typically conveyed during an HIV pretest encounter in a clinic. We used multiple regression to estimate associations between testing modality (online vs clinic based) and two outcomes—HIV test knowledge and change in condom use pre/post-test—with adjustment for relevant background factors.

Results Among 352 participants, online testers demonstrated higher HIV post-test knowledge than clinic-based testers (mean score 4.65/6 vs 4.09/6; p<0.05); this difference was reduced in adjusted analysis (p>0.05). Men who have sex with men, clients with a university degree, those who have lived in Canada >10 years and English speakers had higher HIV post-test knowledge (p<0.05). Eighteen per cent of online testers and 10% of clinic-based testers increased condom use during the 3 months post-test (p>0.05).

Conclusions In this comparative study between online and clinic-based testers, we found no evidence of decreased HIV test knowledge or decreased condom use following HIV testing through GetCheckedOnline. Our findings suggest that with careful design and attention to educational content, online testing services may not lead to missed opportunities for HIV education and counselling.

  • sexual health
  • HIV testing
  • intervention studies
  • patient education

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  • Handling editor Jackie A Cassell

  • Contributors TS conducted analyses, wrote the first draft of the manuscript and led manuscript preparation. MG is the principal investigator of this study and led the overall conduct of the study. DT led the substudy to develop the HIV test knowledge instrument. KT assisted with data preparation and analysis. TS, KT, DH, EE, TW, CKF, TG, JS and GO contributed to the study design and interpretation of study findings. All authors have reviewed and contributed to the manuscript.

  • Funding This work was supported by the Canadian Institutes of Health Research grant numbers PHE-114129 and PHE-318068.

  • Competing interests TS, KT, DH, TG, JS, GO and MG report the above named grants from Canadian Institutes of Health Research during the conduct of the study.

  • Patient consent Not required.

  • Ethics approval University of British Columbia Clinical Research Ethics Board (H11-01168).

  • Provenance and peer review Not commissioned; internally peer reviewed.

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