Research has revealed that one of the many regular screenings patients missed during the peak of the COVID-19 pandemic was for sexually transmitted infections.
Emory University is one of many healthcare organizations stepping in to meet the need. The Georgia-based health system has turned to the popular LGBTQ+ dating app Grindr to bring its program to the masses.
A new study in The Lancet assessed testing rates in four states to find that screening decreased between 68% and 97% in outpatient settings. With an unknown number of Americans being untreated for the virus, Emory’s program Together TakeMeHome partnered with Grindr to provide free at-home HIV tests to residents who are 17 years or older in all 50 states and Puerto Rico.
While self-testing has drawn debate, Professor of Epidemiology at Emory University Patrick Sullivan told Fierce Healthcare that he thinks there’s nothing wrong with providing more avenues to care.
“We are taking HIV out of a privileged position, which for many years, we had a lot of support in place and we were doing HIV testing with substantial counseling and support,” Sullivan said. “This is the last step in a journey in letting people take control of understanding this aspect of their health. Through a series of rigorous scientific investigations, we know that people are going to be able to get linked to care, that we can get the kits to those who need them most, that we can provide support.”
Grindr lights the beacon of at-home HIV testing
It has been over a decade since OraQuick’s at-home HIV test won FDA approval. A designated button on the Grindr side menu now gives users the ability to order the at-home test kit for free.
Grindr boasts over 12 million monthly users and is one of the most well-known dating apps for the LGBTQ+ community.
In less than a minute the OraQuick reactive test reveals the presence of HIV. If the result is positive, a confirmatory test should be taken with a provider, Sullivan said.
Both OraQuick and Emory maintain hotlines in English and Spanish to support patients through the testing process, connect with a provider and ensure that patients receive treatment.
Before the pandemic, Sullivan said, there were already patients who tested positive and never received care or patients in high-risk groups who simply weren’t getting tested. People may be hesitant to bring it up to their provider due to stigma or fear of the results or they may not have a primary care provider at all.
“When people order kits, we get some information about their testing history, and we know that nearly a quarter of those who order a kit have never tested for HIV before and another quarter were tested over a year ago,” Sullivan said. “There are a variety of reasons why people either might want to supplement testing they get at the doctor's office or feel more comfortable having a first test at home.”
For high-risk groups already testing at annual primary care appointments, OraQuick provides a way to increase testing frequency. The Centers for Disease Control and Prevention (CDC) recommends that everyone between the ages of 13 and 64 gets tested at least once but more often for those with risk factors that increase chances of contracting the virus.
“HIV self-testing gives people the power to test on their own terms,” said Robyn Neblett Fanfair, M.D., acting director of the CDC’s Division of HIV Prevention, in Emory’s statement regarding the program. “Removing barriers to testing like stigma, discrimination and access to physical services improves health, advances health equity and moves our nation closer to ending the HIV epidemic.”
To at-home test or at-home collect, and what to test for?
Founder of Ash Wellness David Stein told Fierce Healthcare he thinks that at-home testing creates the possibility for patients to not seek additional medical attention which would ultimately lead to decreased governmental contact tracing and medical support.
Ash Wellness patients are sent an at-home sample collection kit which is then sent to a lab just as if it were taken at a doctor’s office.
A primary goal of the health tech startup is creating linkages to care, reflected in its business-to-business model serving healthcare organizations. Healthcare providers meet with patients virtually before and after tests to ensure continuity of care, contact tracing and patient support.
“If you're receiving that reactive result immediately, even though you must seek out a conclusive result, it's extremely terrifying, which is why we do what we do so that the patient isn't on their own,” Stein said.
Ash Wellness advertises on queer dating sites and sees apps as a prime point for public health education. One point of recent education has been the need for increased STI testing overall.
Both HIV and overall STI testing decreased over the pandemic. Plus, pre-exposure prophylaxis has meant that while the chances for contracting HIV has decreased for those on the drug, users might be less likely to use condoms, therefore inadvertently contracting or transmitting other STIs. Altogether, from 2020 to 2021, rates of syphilis increased 32%.
Simple HealthKit is launching a new offering to meet the post-COVID need for testing for sexually transmitted infections. Today the company announced its expanded at-home diagnostic services for chlamydia, gonorrhea, trichomoniasis, HIV and syphilis.
“Because HIV was so devastating a lot of resources were put into the science behind creating medications that would decrease transmission and lengthening life expectancy and because other infections are curable, there's not so much emphasis placed on gonorrhea, chlamydia and the effects they can have on your body,” Kerry-Ann Kelly, M.D., medical director of innovation and health equity at Simple HealthKit, told Fierce Healthcare.
The company opts for at-home collection but is on the same page as Together TakeMeHome regarding education. One thing she wished more patients knew is that while other STIs are curable, pelvic inflammatory disease, caused by untreated STIs, is the number one cause of infertility in women.
“There’s not sexual health education that's built into the education system, and then there’s a stigma that comes with HIV and seeking treatment and asking the right questions,” Kelly said. “Being able to get yourself tested really changes the conversation, and how we educate about HIV and other STIs changes the conversation.”