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A cohort study comparing rate of repeat testing for sexually transmitted and blood-borne infections between clients of an internet-based testing programme and of sexually transmitted infection clinics in Vancouver, Canada
  1. Mark Gilbert1,2,
  2. Travis Salway1,2,
  3. Devon Haag1,
  4. Elizabeth Elliot3,
  5. Christopher Fairley4,
  6. Mel Krajden1,5,
  7. Troy Grennan1,5,
  8. Jean Shoveller2,
  9. Gina Suzanne Ogilvie1,2
  1. 1 BC Centre for Disease Control, Vancouver, British Columbia, Canada
  2. 2 School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  3. 3 British Columbia Colleage of Nursing Professionals, Vancouver, British Columbia, Canada
  4. 4 Melbourne Sexual Health Centre, Carlton, Victoria, Australia
  5. 5 Department of Medicine, 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}


Objectives Internet-based sexually transmitted and blood-borne infection (STBBI) testing services reduce testing barriers through bypassing face-to-face clinical encounters, potentially enabling clients at ongoing sexual risk to test more frequently. To our knowledge, this hypothesis has not been previously tested. We compared the frequency of repeat testing between Vancouver-based clients of GetCheckedOnline (GCO)—an internet-based STBBI testing service in British Columbia, Canada—and clients of three sexually transmitted infection (STI) clinics in Vancouver for 29 months after GCO launched.

Methods An administrative data cohort (n=19 497) was assembled using GCO, clinical and laboratory databases. We included all individuals who tested for HIV, gonorrhoea/chlamydia, syphilis or hepatitis C at three STI clinics or using GCO, between September 2014 and February 2017. The rate of repeat testing (>30 days after first episode) was compared between clients who used GCO at least once and those who tested only in STI clinics. Poisson regression was used to generate relative rate (RR) for repeat testing, with adjustment for age, gender/sexual orientation, risk factors (eg, history of STI diagnosis) and rate of testing before GCO launched.

Results 1093 GCO clients were identified, of whom 434 (40%) had repeat test episodes; 8200/18 404 (45%) of clinic clients tested more than once. During the 29-month analysis period, GCO clients repeat tested 1.87 times per person-year, whereas clinic clients repeat tested 1.53 times per person-year, resulting in a crude RR of 1.22 (95% CI: 1.14 to 1.31). Adjustment for covariates increased the RR to 1.26 (95% CI: 1.15 to 1.37).

Conclusions In this cohort, individuals using internet-based STBBI testing had a rate of repeat testing 22% greater than clinic-based clients. This effect was increased after adjusting for characteristics associated with higher test frequency. The online interface of GCO may facilitate more frequent testing and may therefore contribute to earlier STBBI diagnosis.

  • HIV
  • testing
  • communication technologies
  • health services research
  • implementation science

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  • Handling editor Claudia S Estcourt

  • Contributors MG is the principal investigator of this study and led the overall conduct of the study and manuscript preparation. TS conducted analyses and contributed to manuscript preparation. DH and MK assisted with securing data, preparation and analysis. TS, EE, MG, CKF, MK, JS and GO contributed to the study design and interpretation of study findings. All authors have reviewed and contributed to the manuscript.

  • Funding Funding for this study was provided by the Canadian Institutes of Health Research (grants PHE-114129, PHE-318068), which played no other role in this study.

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

  • Patient consent for publication This study used available health administrative data and individual patient consent was not required. Use of GetCheckedOnline data for this study was consistent with the terms of use agreed to by all users of the service.

  • Ethics approval Ethics approval for this study was obtained from the research ethics board at the University of British Columbia (approval number H11-01168).

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

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