Building Healthy Online Communities (BHOC), in partnership with Emory University and NASTAD, developed the National Home Test Kits program for state and local health departments to offer confidential HIV and comprehensive STD testing delivered securely and discreetly directly to their constituents.
TakeMeHome™ is designed with a focus on reaching men who have sex with men (MSM) who use dating apps, though the platform is open to all people over age 17 who haven’t had a recent HIV test. We are eager to support health partners who are also prioritizing other communities who could benefit from home testing, including trans and non-binary people, sex workers, and people who inject drugs.
Why we support home testing:
- Home testing is a great way to reach those who aren’t getting tested. Fully 1/3 of TakeMeHome™ users report never having had an HIV test before. Additionally, the 2019 American Men’s Internet Survey found that 22% of MSM who use dating apps reported that they had NEVER tested for HIV.
- Research on HIV and STI prevention strategies supports at-home testing, especially during the COVID-19 pandemic. Check out a recent paper here.
- It’s endorsed by people who face significant barriers to on-site testing services. TakeMeHome™ users–especially those who are trans, disabled, or living in rural areas–have told us that home-testing is the best option to keep them on top of their sexual health.
Updates (as of September 24, 2021):
- The CDC’s Morbidity and Mortality Weekly Report (MMWR) highlighted our program.
- Our Spanish language version of TakeMeHome™ is live!
- Follow us on Instagram for program updates.
Check out the ordering process for HIV OraQuick tests below. You can see the process for STI test kits here.
“What a great program. Smooth process without the anxiety of a doctors office.”
“After losing my job and benefits, I could not afford the tests any longer. Thank you for this wonderful service.”
“Wonderful service as I’ve been too scared to go get tested. This’ll make it much easier for me just to take at home. Otherwise, I’m not sure when i would get the courage to go get tested.”
To make mailed HIV/STI testing most efficient for public health partners, we created the following strategy:
1) Centralized system for HIV/STI test kit ordering and distribution
We have developed a centralized HIV/STI test kit-ordering and fulfillment system. Public health agencies who opt in to using the system can choose the type and numbers of mailed tests, the duration of their participation, and the eligible populations they would like to target.
2) Testing options
Users will be sent an HIV oral rapid in-home test, with detailed instructions and information about confirmatory testing and HIV and STI prevention and care resources. STI testing swabs and HIV dried blood spot testing is available in select areas, which users can send specimens to a laboratory in the postage-paid return packet that will be included. Hepatitis C testing is available for those who are eligible. For participants using PrEP, we have a PrEP panel option, which includes HIV dried blood spot and creatinine testing.
Dating apps will promote this opportunity through messaging and advertisements. New jurisdictions will get a minimum of 2 messages per month for the first 4 months of participation. Users of geospatial social networking apps, like Grindr, can order by clicking on a link embedded within sexual health-related content of their apps. Public health agencies can also include the ordering links in their other health promotion materials. We provide a bilingual (English/Spanish) social media toolkit of images and captions for use in digital and printed outreach materials.
4) Results delivery
Users of the OraQuick self-administered swab will get their results at home. We also offer laboratory-based HIV and STI testing. In locations where STI testing is available and users select it, they are able to access results of laboratory-based testing of self-collected specimens using a secure, self-service results portal. Users with positive test results will get follow-up through their local jurisdiction, as well as links to geo-targeted testing and care services. All users will receive basic information about STI testing, PrEP, condoms, and U=U. All positive results for tests with required reporting will be automatically reported to the health department.
Costs of participation:
The cost is calculated based on the number of tests purchased. This cost includes promotion through the apps (though jurisdictions may also choose to supplement this), test kits, delivery/fulfillment, and participant survey data.
The current cost for HIV OraQuick testing is $46 per kit; so, if your jurisdiction aims to send out 100 kits, plan to budget $4600. For HIV dried blood spot, STI, and PrEP panel lab-testing pricing information, please contact Jen.
Frequently Asked Questions
Has this been tried before? What’s the evidence that it works?
Virginia, Arizona, and New York City have piloted the delivery of home test kits and have found that this process enabled them to reach individuals who hadn’t tested recently. In most cases, they have had a higher positivity rate than traditional testing strategies.
- New York City: 28% of testers hadn’t tested in the previous year and 14% hadn’t ever tested. They reported a positivity rate of 0.3%
- Virginia: 29% of testers hadn’t tested in the previous year and 21% hadn’t ever tested. They reported a positivity rate of 1.3%; 88% of new positives were linked to care within 30 days.
- Arizona reported a positivity rate of 1.2%.
For more information about home testing from the CDC, including study results from other home testing programs, click here.
Who are these tests targeting?
Promotion will happen predominantly through gay dating apps due to our relationships with these apps. Health departments have the opportunity to promote this program to whichever populations they choose and will have greater flexibility to choose their eligibility criteria. We are looking to expand our target populations as the program evolves.
What happens with linkage to care and support for individuals who test positive?
For OraQuick tests, individuals will get information in their test kits about what to do in the case of a positive result. This will include how to obtain a confirmatory test at a local clinic, and the number of OraSure’s hotline if needed. (Some states or jurisdictions may already have or want to create a hotline for this purpose.)
Following a preliminary positive result at home, when an individual comes in for confirmatory testing, they will be known to the jurisdiction’s HIV care and surveillance systems.
For lab-based testing, users can access their results through a client portal. The health department will also receive positive results through a secure file.
What happens to those who are not eligible?
If a user is ineligible, either because he does not live in a participating jurisdiction or because they have been tested within the past 12 months, TakeMeHome will link them to other home testing or test sites near them. The site also has information regarding prevention strategies.
What happens to individuals from non-participating jurisdictions?
They are given information about other home testing or testing sites near them, through the CDC-maintained database.
Which tests are included in STI testing?
STI testing includes 3-site chlamydia and gonorrhea, syphilis, and HIV. HCV testing is included based on the user response to a risk questionnaire.
How does syphilis testing work?
For at-home collection of syphilis samples, our lab partner will provide a dried blood spot (DBS) card.
The DBS sample is first tested using an EIA assay for the qualitative detection of IgG antibodies to T. pallidum.
If negative, then the sample is reported as “not detected.”
If positive, then the sample is repeated in duplicate using the EIA assay.
The client is informed through the results portal that they need to get additional testing and follow-up care.
Only clients who have not had a previous syphilis diagnosis will receive syphilis testing. Those who have tested positive for syphilis before will be informed they will not receive testing and linked out to local resources.
How is this program run? Who houses the testing kits and fulfils orders?
TakeMeHome and its delivery subcontractor takes care of all that. It is handled by a company that we have a contract with. All of these services are included in the cost. Each health department orders the number of kits they want; TakeMeHome takes care of the rest, as well as promotion. Additionally, health departments may modify the numbers of tests they order during a given time period.
Can PS18-1802 HIV grant funding or other funds be used to participate in the program?
You can use PS18-1802 funds or other funds for this program. Payment is made through NASTAD.
What data will be made available to participating health departments?
We will make the following data available:
- # of people from each jurisdiction who visited to the TakeMeHome website
- Client-level detail for each kits sent out, including: Name, Mailing address (including zip code), Email, number of kits ordered, Age, Sex at Birth, Time since last HIV test (phone number required for lab testing)
- # of kits sent out
- Follow-up client surveys include the following: Race/ethnicity, Gender identity, Transmission category, Where their most recent HIV test was, Whether they took the test, Test result information, Linkage information, Access to PrEP, Access to STI testing, Feedback about their experience
We are currently building into the system the following additional metrics to include the following:
- # of ad impressions, clicks, and click-through rates
- # of views of those sites provided to users
- # of people who fill out the eligibility survey
- # determined to be eligible, by jurisdiction
- # STI or HIV DBS results returned for lab-based testing
- % of lab-based testing samples returned properly
- positivity rate (# new cases identified), by jurisdiction
- linkage to care among new positives
- # of people who complete the post-test survey
- completion rate for post-test survey
What is in place in regards to data security and HIPAA protections?
We have worked closely with our Compliance Officer, IT, and legal teams to ensure the highest quality data security and HIPAA practices. Our lab testing partner, Molecular Testing Labs, has a secure lab portal for STI and lab-processed results and they ensure HIPAA protections are in place for all of their services. We have a signed BAA in place with MTL that covers all participating jurisdictions. Each participating jurisdiction can also find a detailed Business Associate Agreement that refers to our relationship with Health Departments here.
Can an individual order more than one HIV oral swab test?
Yes, jurisdictions could opt between allowing participants to order just one HIV oral swab test for themselves or two. In the future, we are open to expanding this more widely, based on requests from jurisdictions.
Evidence has pointed to increased positivity rates among individuals who give test kits to their partners and peers.
How will our surveillance team know about new positive results?
It’s helpful to remember that at any point, anyone in your jurisdiction can walk into a Walgreens and purchase this test over the counter or order one online. The only difference is that your state is now supporting people who haven’t tested recently to get easier access to these tests. Your surveillance team will know about these positives as individuals come in for confirmatory testing. We encourage each participating jurisdiction to run periodic matches between the data we send and their surveillance data.
What’s the process and options for distributing State-specific messages or information about State/local resources in association with the test kits?
We are building the platform with that in mind. We will have multiple opportunities for participating jurisdictions to put in their own campaign messages.
What jurisdictions are currently participating?
We are excited to be working with our jurisdictional partners to expand home-testing across the U.S. Here’s who is on board:
- California: Alameda County Public Health Department, Los Angeles County Department of Public Health, Orange County Health Care Agency, Riverside County Public Health, Sacramento County Public Health, San Bernardino County Department of Public Health, San Diego County Health and Human Services Agency, San Francisco Department of Public Health, San Francisco AIDS Foundation
- Colorado: Tri-County Health Department
- Idaho Department of Health and Welfare
- Indiana: Marion County Public Health Department
- Louisiana: New Orleans Health Department
- Maine Center for Disease Control & Prevention
- Missouri: City of St. Louis Department of Health
- Montana Department of Public Health and Human Services
- New Jersey Department of Health
- North Carolina Department of Health and Human Services
- Oregon Health Authority
- South Carolina: Pride Link
- Texas: Tarrant County Public Health
- Wyoming Department of Health
List updated November 15, 2021
Contact firstname.lastname@example.org to learn more
TakeMeHome Research & Presentations
- Increasing Access to HIV Testing Through Direct-to-Consumer HIV Self-Test Distribution (Centers for Disease Control and Prevention, 2021)
- Self-Testing Strategies for HIV Testing and PrEP Access: Providing At-Home Testing Through the BHOC Partnership (NASTAD, 2020) | Webinar Video & Slides
- Rapid Uptake of Home-Based HIV Self-testing During Social Distancing for SARS-CoV2 Infection in Oregon. (Journal of AIDS and Behavior, 2021)
- National Home Test Program Project Brief
- Greater Than AIDS has launched a webpage of FREE HIV self-testing programs available around the country to help individuals find more options during COVID-19.