The TakeMeHome (TMH) program mailed free at-home sexually transmitted and blood-borne infection (STBBI) testing kits for HIV, hepatitis C, syphilis, chlamydia and gonorrhea to participants who requested them through dating apps. The program was developed to increase STBBI testing rates among gay, bisexual and other men who have sex with men (gbMSM). Test specimens were self-collected and mailed to laboratories for processing; participants were notified of their results electronically and linked to care as needed. The program was able to reach first-time testers, with approximately 24% of participants stating that this was their first HIV test. The positivity rate of tests was 1.4% for HIV, 0.6% for hepatitis C, and 2.9% for chlamydia, gonorrhea and/or syphilis combined.
Program description
The TMH program mailed free at-home STBBI test kits that were advertised through dating apps (e.g., Grindr, Sniffies, GROWLr, Adam4Adam) to participants aged 18 years and over. The kits could include tests for HIV (antibody and confirmatory), hepatitis C (antibody) and syphilis (antibody) using dried blood spot (DBS) tests, creatinine, as well as three-site tests (urine, rectal and pharyngeal swabs) for chlamydia and gonorrhea. Health departments were responsible for determining which test kits to provide on the basis of local surveillance data (not all tests were available in all areas) and procuring the kits. They also followed up on any positive results to link participants to care. The health departments were responsible for any additional optional promotional strategies that took place outside of dating apps.
App users were sent messages about the program and were linked to the TMH website where they completed screening questions and created an account to order a test kit. Screening questions included questions on STBBI symptoms, prior syphilis diagnosis and behaviours; the answers were used to determine which test kits participants could receive. For example, people were asked about specific activities that may put them at risk for hepatitis C (e.g., injection drug use, having a tattoo in an unregulated setting, having an HIV infection) to determine their eligibility for a hepatitis C test kit. If someone was experiencing symptoms of a sexually transmitted infection they were directed to an in-person clinic for testing services and did not receive a test kit by mail.
Kits were sent out within 24 hours of ordering via priority mail with paid postage for their return to the laboratory for processing. Test kits were sent to participants directly from the testing laboratory and all specimens were self-collected. Kits contained:
- all required collection supplies (e.g., swabs, urine cup, lancet, and/or DBS card)
- directions on how to use each collection supply
- a link to a video for instructions on how to self-collect specimens
It was recommended that participants include samples that were relevant to their sexual activities using the slogan “If you use it, swab it.” The kit was valid for up to 60 days from receipt and within 30 days of specimen collection.
Follow-up
Participants were informed that positive test results would be reported to local health departments. Health departments identified a clinician who could follow up with participants as needed (e.g., facilitate confirmatory testing and any needed treatment).
Participants received an automated email with a link to sign into their account to view their results when they were available. Participants with positive results were directed to additional information and were then contacted by the local health department or a clinical provider for any required follow-up (e.g., confirmatory testing) and linkage to care if required.
Results
From January 2021 to September 2022, 2,285 kits were mailed, and 1,068 (46.7%) total orders were returned and processed (1,217 kits were not returned within 60 days). Of those who ordered kits:
- 25% were aged 15 to 24 years, 21% were aged 25 to 29 years, 34% were in their 30s and 20% were 40 years of age or older
- 44% self-identified as White, 76% as Black, 18% as Hispanic, 10% as Asian or Pacific Islander and 21% as another race
- 68% self-reported being a man, 23% a woman, 8% genderqueer and <1% another gender
- 24% self-reported TMH as their first HIV test
Almost half of kits ordered, 48.3% (1,104/2,285), included testing for all STBBIs (i.e., HIV, hepatitis C antibodies, syphilis antibodies and three-site chlamydia and gonorrhea testing). Those who identified as women were 26% less likely to return kits than men, and genderqueer people were 40% less likely to return kits than men when the results were adjusted for age, race and jurisdiction (both statistically significant). There were no differences in return rates by race. Of all specimens returned, 95% were sufficient for processing.
The positivity rate of tests during this period were:
- 1.4% for HIV
- 0.6% for hepatitis C
- 2.9% for chlamydia, gonorrhea and/or syphilis combined
Other statistically significant results showed that:
- rates of STBBIs were 2.15 times higher among Hispanic participants and 1.79 times higher among participants in the “other” race category than among White participants, after adjustment for differences in age, gender and jurisdiction
- compared with among women, rates of STBBIs were 3.37 times higher among men and 4.82 times higher among genderqueer people when adjusted for age, race, and jurisdiction
Implications for service providers
This study shows that mailing out test kits and self-collection of specimens has the potential to improve STBBI testing for gbMSM. In addition to showing that this approach is feasible, TMH also demonstrates that the approach is acceptable and can reach first-time testers and undiagnosed people who may not otherwise get tested for HIV and other STBBIs, as well as establish linkage to care protocols. The study authors stated that wider support for regulations surrounding mail-based testing using self-collected samples is needed for this approach to be more widely used, as options are currently limited.
Related resources
A linkage to care program to enhance the engagement of people living with HIV – evidence brief
Sexually transmitted infection testing interventions: community and service provider preferences – evidence brief
Medicine Bundle for HIV self-test kit distribution – evidence brief
Reference
Hecht J, Facente SN, Cohen S et al. TakeMeHome: A novel method for reaching previously untested people through online ordering and self-collect HIV and STI testing. Sexually Transmitted Diseases. 2024; 51(12):803-809.