TakeMeHome™ – a new free HIV/STI home testing program

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 STD testing delivered securely and discreetly directly to their constituents.
TakeMeHome is designed to reach men who have sex with men (MSM) who use dating apps. We are eager to support health partners who are prioritizing other communities who could benefit from home testing in the future, including trans and non-binary people, sex workers, and people who inject drugs.
The 2019 American Men’s Internet Survey found that 22% of MSM who use dating apps reported that they had NEVER tested for HIV.
We also know there is significant customer demand for home tests: 77% of survey respondents wanted apps to add this feature. Easy access to home tests was even more popular (83%) among those who had never tested.
To reach individuals who are not testing consistently (or at all), and may not be accessing current testing options, home testing is a great way to reach those who aren’t getting tested.

“What a great program. Smooth process without the anxiety of a doctors office.”

- Participant

To make mailed HIV/STI testing most efficient for public health, 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. We are expanding the options to include STI testing swabs and HIV dried blood spot testing, which users can send to a laboratory in the postage-paid return packet that will be included. For participants using PrEP, we are also adding a PrEP panel option, which includes HIV dried blood spot and creatinine testing.

3) Promotion
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
Users of the OraQuick self-administered swab will get their results at home. In the near future, we will also offer laboratory HIV and STI 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 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 is $46 per kit, so if your jurisdiction aims to send out 100 kits, plan to budget $4600.
For lab-testing pricing information, please contact Jen.

Self-Testing Strategies for HIV Testing

NASTAD’s webinar, Self-Testing Strategies for HIV Testing and PrEP Access: Providing At-Home Testing Through the BHOC Partnership, held on October 15, 2020, provided an overview of self-testing initiatives and highlighted the Take Me Home program, which included details about expanding self-testing options to STI and PrEP panels.

Frequently Asked Questions

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 some cases, they have succeeded in reaching 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.

For the time being, the national resource will focus on the 30% of all MSM who haven’t tested for HIV in at least one year. Promotion will happen predominantly through gay dating apps. Health departments will soon 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.

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.

Once HIV dried blood spot testing is implemented, users can access their results through a client portal. The health department will also receive positive results through a secure file.

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 gettested.cdc.gov/ to find test sites near them. The site also has information regarding prevention strategies.

They are given information about testing sites near them, through the CDC-maintained database.

TakeMeHome is expanding to offer STI self-collection. We estimate launching this in fall 2020.

For at home collection of syphilis samples, Molecular will provide a DBS card and microtainer. (especially for those with a known history of syphilis).

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.  If at least one of the duplicate repeats are positive, the microtainer sample reflexes to RPR qualitative (POS or NEG).

If the RPR is positive, then a full titer is performed.

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.

You can use PS18-1802 funds or other funds for this program. Payment is made through NASTAD.

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, Number of anal and/or vaginal sex partners, 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

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, MTL, has a secure lab portal for STI results (when this feature becomes available) 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 will get a copy of this BAA for their records.

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.

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 MSM 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 are building the platform with that in mind. We will have multiple opportunities for participating jurisdictions to put in their own campaign messages.

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. Learn more.

Contact jhecht@sfaf.org to learn more

Program Partnerships