Background Advances in STI/HIV diagnostics and digital health enable people to self-sample, self-test and receive results remotely. However, concerns remain about poor support and linkage to care. We explored how people access online HIV resources and how technology can facilitate testing, to inform development of software linking those with reactive results to care, and those with negative results to testing/retesting for HIV and other STIs, health promotion and biomedical interventions (e.g. PrEP).

Methods A prototype was developed following the eClinical Care Pathway Framework which consists of an interdisciplinary 9-step approach. A convenience sample of people (n=28, aged 25–60, 36% female, 57% MSM, ethnically-diverse, 6 people living with HIV) participated in semi-structured interviews and ‘think-aloud’ exercises exploring the following user journey using existing online and remote testing resources: contemplating testing→searching for information online→choosing how to test→ordering a test→experiences using HIV self-sampling/self-testing→receiving a result→engaging with care. The content and sequence of a paper prototype HIV online results service and negative/reactive pathways were cognitively tested. Findings informed the design of a software prototype which was iteratively developed with further user testing. Qualitative data were analysed thematically.

Results Existing HIV online and remote testing resources failed to 1) meet participants’ needs and expectations related to information provision/support and 2) address anxieties related to testing. Participants expressed strong emotions about the wording and sequence of text with negative/reactive pathways, and highlighted the need for the resource to provide a rationale for collecting sensitive data. Adjusting the way in which information was provided and reactive results were presented attenuated, but did not remove, associated negative emotions. Some participants felt people choosing self-sampling should not receive reactive results online.

Conclusion Tailoring information, careful wording, and clear messaging and signposting throughout online HIV testing/diagnosis care pathways are essential to address expectations, attenuate strong emotional reactions, and support linkage and engagement with care.

Disclosure No significant relationships.