Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review

Background Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects. Methods We followed Arksey and O’Malley’s framework for scoping reviews (2005) integrating adaptations by Levac et al (2010). We searched OVID Medline, Embase, CINAHL, Scopus, Web of Science, Google Scholar and health agency websites for peer-reviewed articles and grey literature comparing uptake of digital STBBI testing with in-person models and/or comparing uptake of digital STBBI testing among sociodemographic strata, published in English between 2010 and 2022. We extracted data using the Place of residence, Race, Occupation, Gender/Sex, Religion, Education, Socioeconomic status (SES), Social capital and other disadvantaged characteristics (PROGRESS-Plus) framework, reporting differences in uptake of digital STBBI testing by these characteristics. Results We included 27 articles from 7914 titles and abstracts. Among these, 20 of 27 (74.1%) were observational studies, 23 of 27 (85.2%) described web-based interventions and 18 of 27 (66.7%) involved postal-based self-sample collection. Only three articles compared uptake of digital STBBI testing with in-person models stratified by PROGRESS-Plus factors. While most studies demonstrated increased uptake of digital STBBI testing across sociodemographic strata, uptake was higher among women, white people with higher SES, urban residents and heterosexual people. Co-design, representative user recruitment, and emphasis on privacy and security were highlighted as factors contributing to health equity in these interventions. Conclusion Evidence of health equity effects of digital STBBI testing remains limited. While digital STBBI testing interventions increase testing across sociodemographic strata, increases are lower among historically disadvantaged populations with higher prevalence of STBBIs. Findings challenge assumptions about the inherent equity of digital STBBI testing interventions, emphasising the need to prioritise health equity in their design and evaluation.

or social class or social status or social capital or socioeconomic* or poverty or hard-to-reach).mp.[mp=title, abstract, heading   BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)

Data Collection
What types of data are collected/managed/shared?How is this data collected/managed/shared? (describe the tool, if there is one) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)

Self-sample collection and postal
To examine whether the CSI reached the right populations for screening.

MemoDépista ges Programme
Web-based testing

Self-sample collection and postal
To assess different factors that impact the overall participation in the first screening round of the programme Overall, 3428/7158 men (47.9%) accepted kits, among whom 1948 (56.8%) returned samples.Sample return was lower for men who had not attended college (aOR 0.65, 95%CI 0.56-0.76),those reporting difficult financial situation (aOR 0.7, 95%CI 0.58-0.86compared with those with a good situation.Participation rates were lower for men ≥ 30 years (aOR=0.66,95%CI 0.58-0.75)vs those <30.No differences were found by place of residence.Web-based testing

Self-sample collection and postal
To assess the sexual health needs, practices, STI/HIV positivity, and satisfaction rates of trans and nonbinary people in a large STI screening e-service.
There was no difference in kit return rates between Trans and non-binary (TNB) and cisgender individuals (OR 1.00 95% CI 0.81-1.24).TNB users were more likely to return blood samples than cisgender users (OR 1.6 95%CI 1.06-2.36).Similar proportion of TNB and cisgender users received testing after registration.
STI positivity rates were higher among TNB vs. cisgender users for all STBBIs.

Self-sample collection and postal
To assess the effectiveness of an e-STI testing and results service (chlamydia, gonorrhoea, HIV, and syphilis) on STI testing uptake and STI cases diagnosed.
At 6 weeks, 50.0% of the intervention group had completed an STI test compared to 26.6% in the control group (RR 1.87, 95%CI 1.63-2.15);2.8% of the intervention group vs 1.4% in the control group had been diagnosed with an STI (RR 2.10, 95%CI 0.94-4.70).The proportion of participants treated was 1.1% in the intervention group vs 0.7% in the control group (RR 1.72,).Time to test was shorter in the intervention group compared with the control group (28.8 days vs 36.5 days).No differences were observed for time to treatment (83.2 days vs. 83.5 days).STI testing was increased in all sub-groups with no outcomes difference between sub-groups.
Web of science search (ALL=(HIV or HBV or Hepatitis B or HCV or Hepatitis C or chlamydia or gonorrhea or gonorrhoea or syphilis or human papilloma virus or HPV or sexually transmitted infection or sexually transmitted diseases or herpes genitalis or sexually transmitted disease or blood-borne infection or blood-borne infections or STI or stbbi or STD) AND ALL=(Online or digital or digital technology or internet-based or web-based or eHealth or mHealth or app or apps or mobile application or smartphone or telemedicine or virtual) AND ALL=(Testing or screening or self-sampling or self-test* or self-collect* or home-testing or diagnos*) AND ALL=(Health equity or equit* or inequit* or dispari* or equal* or unequal or discriminat* or marginali* or underserved or vulnerab* or disadvantage* or rural or racial* or race or ethnic* or unemploy* or gender or literacy or literate or illitera* or youth or young* or elder* or educational status or educational attainment or educational level or gay men or bisexual men or gbmsm)) NOT ALL=(systematic review or protocol or scoping review) Google scholar strategy: March 15 digital OR online OR internet-based OR web-based OR eHealth OR mHealth OR mobile OR smartphone OR telemedicine test OR OR OR testing OR OR OR screening OR OR OR equity OR OR OR Health OR equity "sexually transmitted infection" Health equity or equit* or inequit* or dispari* or equal* or unequal or discriminat* or marginali* or underserved or vulnerab* or disadvantage* or rural or racial* or race or ethnic* or unemploy* or gender or literacy or literate or illitera* or youth or young* or elder* or educational status or educational attainment or educational level or gay men or bisexual men or gbMSM or homosexual men or sexual minority or transgender or queer or lesbian or bisexual or two-spirit or intersex or stigma* or old* or women or social class or social status or social capital or socioeconomic* or poverty or hard-to-reach).mp.[mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term OR sexual AND minority OR transgender OR queer OR lesbian OR bisexual OR twospirit OR intersex OR stigma* OR old* OR women OR social AND class OR social AND statu s OR social AND capital OR socioeconomic* OR poverty OR hard-toreach ) AND KEY ( testing OR screening OR self-sampling OR self-test* OR selfcollect* OR hometesting OR diagnos* ) AND KEY ( online OR digital OR digital AND technology OR internetbased OR webbased OR ehealth OR mhealth OR app OR apps OR mobile AND application OR smartphone O R telemedicine OR virtual ) AND KEY ( hiv OR hbv OR hepatitis AND b OR hcv OR hepatitis AND c OR chlamydia OR gonorrhea OR gonorrhoea OR syphilis OR human AND papilloma A ND virus OR hpv OR sexually AND transmitted AND infection OR sexually AND transmitted AND diseases OR herpes AND genitalis OR sexually AND transmitted AND disease OR bloodborne AND infection OR bloodborne AND infections OR sti OR stbbi OR std ) ) AND PUBYEAR > 2009 blood-borne infections/ or exp hepatitis b/ or exp hepatitis c/ or exp hiv infections/ or exp sexually transmitted diseases/ (HIV or HBV or Hepatitis B or HCV or Hepatitis C or chlamydia or gonorrhea or gonorrhoea or syphilis or human papilloma virus or HPV or sexually transmitted infection or sexually transmitted diseases or herpes genitalis or sexually transmitted disease or blood-borne infection or blood-borne infections or STI or STBBI or STD).mp.[mp=title, abstract, headingword, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term word] 1 or 2 exp Telemedicine/ or exp Internet/ (Online or digital or digital technology or internet-based or web-based or eHealth or mHealth or app or apps or mobile application or smartphone or telemedicine or virtual).mp.[mp=title, abstract, heading word, drug trade name, original title, device manufacturer, drug manufacturer, device trade name, keyword heading word, floating subheading word, candidate term https://access.ovid.com/custom/redirector/index.html?dest=https://go.openathens.net/redirector/ubc.ca?url =http://ovidsp.ovid.com/ovidweb.cgi?T=JS&NEWS=N&PAGE=main&SHAREDSEARCHID=4gzXDxq kn1ayMnb0QgTnQQyADlUy3vaKPsFOucHfj15bHhUrbjKTesaFEufsfMV47 Ovid Medline search Database: Ovid MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations, Daily and Versions <1946 to March 14, 2022>(HIV or HBV or Hepatitis B or HCV or Hepatitis C or chlamydia or gonorrhea or gonorrhoea or syphilis or human papilloma virus or HPV or sexually transmitted infection or sexually transmitted diseases or herpes genitalis or sexually transmitted disease or blood-borne infection or bloodborne infections or STI or STBBI or STD).mp.[mp=title, abstract, original title, name of substance word, subject heading word, floating sub-* or race or ethnic* or unemploy* or gender or literacy or literate or illitera* or youth or young* or elder* or educational status or educational attainment or educational level or gay men or bisexual men or gbMSM or homosexual men or sexual minority or transgender or queer or lesbian or bisexual or two-spirit or intersex or stigma* or old* or women or social class or social status or social capital or socioeconomic* or poverty or hard-to-reach).mp.[mp=title, abstract, original title, name of substance word, subject heading word, floating sub-heading word, keyword heading word, organism supplementary concept word, protocol supplementary concept word, rare disease supplementary concept word, unique identifier,

Key Quotes (for thematic analysis (if needed), add more rows as needed)
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Consideration of the PROGRESS-Plus factors in included articles
BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s) Being TGW(OR 6.66,and having preference towards online services (OR 5.73, 95% CI 2.99-10.98)and home-based HIV testing (OR 6.00, 95% CI 3.1-11.63)increased participants' likelihood to choose online HIV testing and post-test counselling.No difference was found in other PROGRESS criteria in the multivariate analysis.Day 2021 41 Sexual Health London (SHL) BMJ Publishing Group Limited (BMJ) disclaims all liability and responsibility arising from any reliance Supplemental material placed on this supplemental material which has been supplied by the author(s)