(P324) Web-based STI/HIV testing services available for access in Australia – an assessment of their quality and cost

Background

Sexually transmitted infection (STI) rates continue to rise in Australia and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify and assess web-based HIV/STI testing services available in Australia.

Methods

A Google search of Australian web-based STI testing services was conducted in March 2022 and repeated in September 2022 using Boolean operators including test service terms (e.g. online/home), STI terms (e.g. chlamydia/gonorrhoea) and test-type terms (e.g. self-test). The first 10 web-pages were assessed, and services categorized as self-testing (test-at-home), self-sampling (sample at home and return sample to laboratory) or self-navigated pathology (specimens collected at pathology service). Service reliability was assessed against the Health-on-the-Net Foundation Code of Conduct, and quality assessed using a score card we developed based on Australian guidelines. Additional factors were assessed including cost, time till results and rural access.

Results

Seventeen services were identified (8 self-testing, 2 self-sampling, 7 self-navigated pathology). Only 4 offered recommended testing for all four infections (chlamydia, gonorrhoea, syphilis, HIV) at appropriate genital, anorectal and oropharyngeal sites. 5 services offered tests not recommended by guidelines (e.g. ureaplasma). 9 services (1 self-navigated pathology, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-6.0, p=0.115). Quality scores (scale 0-58) were similar between self-navigated pathology and self-sampling services (average 44.89 and 44.75 respectively) but lower for self-testing services (22.66, p=0.002). Cost for services varied between self-navigated pathology ($0-595), self-sample ($0) and self-testing ($0-135). Self-navigated pathology was the fastest way to get results at about four days. Self-testing took the longest at about 14 days.

Conclusion

There was considerable variability in quality and reliability of services identified. It is imperative that Australia develops standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and/or inappropriate tests.