The Advent of Home-Based STI Testing: A Scoping Review to Assess if Programs Address Barriers to STI Testing for Youth [A117

Abstract

INTRODUCTION: Barriers to sexually transmitted infection (STI) testing for youth include a lack of privacy and confidentiality, limited access to affordable testing, and discomfort with providers. Home-STI testing has high acceptability in the U.S., particularly for youth who are at highest risk for STIs. This review sought to identify home-based STI programs that could overcome barriers to testing for youth. METHODS: A scoping review of home-based STI testing programs was conducted. Data on STI test validation, cost, age restrictions, and provider access were collected. RESULTS: Seventeen home-based STI testing programs were identified: 16 were restricted to age ≥18 years, three accepted insurance, four included clinician fees in test cost, and one included medication costs in test cost. Validated self-collected samples (urine, vaginal swab, dried blood spot) were offered for Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, syphilis, hepatitis B, and HIV. Only one program had free testing; the remaining programs charged $45–178 for chlamydia/gonorrhea tests alone and charged more to add other STIs/HIV. Additionally, five did not connect users to providers. No information was documented on prompts to improve test-kit return rates. CONCLUSION: Home-STI testing programs did not address the barriers to STI testing for youth. None were tailored to youth, and the majority had age restrictions. There were expensive out-of-pocket costs, and some programs did not link users who test positive to providers. Home-based STI testing at significantly subsidized costs and home-testing programs customized for youth are needed to help reduce their increasing STI incidence rates and decrease long-term risks of STI-related morbidity.