By Melinda Young

The authors of a recent study show it is feasible for providers to send patients at-home testing kits for sexually transmitted infections (STIs) and expect a majority to be returned with samples.1

STIs have been on the rise for several years across the United States. Finding alternative ways to test people for infections — especially during a pandemic — is important, says Caroline Carnevale, DNP, MPH, principal investigator and family nurse practitioner with the HIV Prevention Program at NewYork-Presbyterian Hospital (NYP).

In New York City and some other large cities, HIV rates were declining pre-pandemic. But HIV rates in other parts of the country, such as the South, have continued to rise, she adds.

In-person services, including STI tests, were halted or decreased significantly at clinics nationwide during the early months of the COVID-19 pandemic. Now, researchers have shown this service can continue by mailing at-home test kits and providing virtual training on how to use the kit.

“We sent out kits to 201 patients and received 74% back,” Carnevale says. “We saw a 15-day turnaround.”

The test kits were mailed during a period of postal service delays in New York. “One of the limitations was that in New York City, packages are always a problem, unless you have a doorman — which most people don’t have,” Carnevale explains. The STI test kit packaging was too large for postal workers to put in mailboxes, so it is possible some of these were left in hallways and misappropriated.

Investigators found that a small pilot study of 447 men who have sex with men (MSM) and their STI rates showed that 25% had an STI at entry to care.1 “Forty-seven percent had one STI while engaging in care with us,” she adds.

Just before the March 22 stay-at-home orders from the New York governor, NYP had switched to an electronic medical record that could be used to improve access to telehealth services, Carnevale says.

“Routine STI screening was definitely shelved,” she adds. “We had patients call us in the early days, saying they were exposed, but it’s not ideal to treat them without testing.”

That was when the team discussed the possibility of home testing, coupled with streamlining telehealth visits. Patients had been visiting the clinic quarterly to receive pre-exposure prophylaxis (PrEP), a daily medication to prevent HIV infection, and to be tested for HIV and STIs. Even before the pandemic, this was asking a lot of patients. When the pandemic hit, it became extremely problematic.

Using money for the pilot study, the team assembled an STI testing kit. It included three swabs for specimens from the mouth, urethra/vagina, and rectum. “The patients received the kit in the mail and then had a telehealth visit with us,” she explains. “We walked them through it on the screen.”

The kits included a welcome pamphlet and contact information for questions. Patients put specimens in the kit’s bottles and returned them via an enclosed, pre-stamped envelope.1

The STI kits tested for gonorrhea and chlamydia. Patients also received the New York City Department of Health and Mental Hygiene’s OraSure 3rd Generation HIV test kit and a video visit with a sexual health provider. The test provides rapid results.1

The OraSure had a separate and higher per-kit cost, but the STI kits were put together using the clinic’s available supplies and cost about $8 per patient and about $4 for shipping, Carnevale says.

“We had a great response from patients,” she says. “Most were upset when the pilot was over and the at-home tests stopped.”

Family planning centers and others that wish to implement at-home STI testing will need to work with labs in advance, Carnevale says.

“I would say there still is going to be pushback about this because it’s an off-label use of the test, and we need to pressure directors of labs,” she explains. “This is incredibly important to patients, pandemic or not.”

Ideally, at-home STI testing would be standard of care, but it is not at that point yet, she adds.

REFERENCE

  1. Carnevale C, Richards P, Cohall R, et al. At home testing for sexually transmitted infections during the COVID-19 pandemic. Sex Trans Dis 2020; doi: 10.1097/OLQ.0000000000001313. [Online ahead of print].