To make mailed HIV testing most efficient for public health, we created the following strategy:
1) Centralized system for HIV test kit ordering and distribution
We have developed a centralized HIV test kit-ordering and fulfillment system based on programs already being implemented by Emory and collaborating public health agencies. 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. Through this system, public health agencies can purchase kits via their NASTAD membership and can request increases to their purchases as needed. (Expansion to non-NASTAD members is now available.) They can also customize content on the platform to align with their own campaigns and prevention/care resource information, and incorporate that information into the delivery system.
2) Testing options
For now, 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. In fall 2020, we will expand the options to include STI testing swabs and HIV dried blood spot confirmatory testing, which users can send to a laboratory in the postage-paid return packet that will be included.
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 HIV-related content of their apps. Public health agencies can also include the ordering links in their other health promotion materials.
4) Results delivery
For now, users will get their results at home using an OraQuick self-administered swab. In the near future, we will also offer laboratory testing. When STI testing is available and users select it, they will be 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 be sent links to geo-targeted testing and care services and all users will receive basic information about STI testing, PrEP, condoms, and U=U. Public health organizations may also choose to provide specific information about services in their area. All positive results for tests with required reporting will be automatically reported to the health department. Public health agencies will have a secure self-serve data dashboard and may access all information on kit ordering, fulfillment and results.