title: Get Checked… Where? The Development of a Comprehensive, Integrated Internet-Based Testing Program for Sexually Transmitted and Blood-Borne Infections in British Columbia, Canada.
abstract: BACKGROUND
  Testing for sexually transmitted and blood-borne infections (STBBI) is an effective public health strategy that can promote personal control of one's health and prevent the spread of these infections. Multiple barriers deter access to testing including fear of stigmatization, inaccurate health care provider perceptions of risk, and reduced availability of clinic services and infrastructure. Concurrent increases in sexually transmitted infection (STI) rates and demands on existing clinical services make this an even more pressing concern. Web-based testing offers several advantages that may alleviate existing clinical pressures and facilitate appropriate testing access.
  
  
  OBJECTIVE
  This paper describes the planning, development, and usability testing of a novel Web-based testing service, GetCheckedOnline (GCO), as a complementary testing option integrated within existing sexual health services within British Columbia (BC).
  
  
  METHODS
  From 2009 to 2014, we engaged a multidisciplinary team in the design and development of GCO. We conducted 3 initial research studies to ascertain the opinions of youth, men who have sex with men (MSM), and STI clinic clients regarding Web-based testing and elicited perspectives of sexual health care providers through focus groups. We developed an informed consent process, risk assessment questions, and test recommendations based on provincial and national guidelines and evaluated these through consultations with clinical and community stakeholders. We also conducted a preliminary health equity impact assessment whose findings also informed the GCO program mode. Finally, from April 2011 to December 2012 we gathered qualitative data from 25 participants on the functionality and usability of a GCO prototype and incorporated their recommendations into a final model.
  
  
  RESULTS
  GCO launched in the fall of 2014 across 6 pilot sites in Vancouver, BC. The service involves 3 main steps: (1) create an account, complete an assessment, and print a laboratory requisition, (2) provide blood and urine specimens at participating laboratory locations, and (3) receive test results on the Internet or by phone. During this pilot phase, we promoted GCO to existing STI clinic clients and MSM in the Greater Vancouver region. A rigorous mixed-method evaluation of GCO's uptake, acceptability, and health system impacts is currently underway.
  
  
  CONCLUSIONS
  GCO is the first comprehensive Web-based STBBI testing program in Canada that is integrated with existing sexual health services, with the potential to reduce pressures on existing clinical services and reach populations facing the greatest barriers to testing. Our experience highlights the facilitators and challenges of developing and implementing novel complex eHealth interventions within the health care system, and underscores the importance of considering broader implementation contexts.
authors.affiliation: British Columbia Centre for Disease Control, Vancouver, BC, Canada. mark.gilbert@bccdc.ca.
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0001-5978-6843
authors.initials: M
authors.lastname: Gilbert
authors.forename: Devon
authors.identifier: http://orcid.org/0000-0003-4955-1017
authors.initials: D
authors.lastname: Haag
authors.forename: Travis Salway
authors.identifier: http://orcid.org/0000-0002-5699-5444
authors.initials: TS
authors.lastname: Hottes
authors.forename: Mark
authors.identifier: http://orcid.org/0000-0003-4663-9267
authors.initials: M
authors.lastname: Bondyra
authors.forename: Elizabeth
authors.identifier: http://orcid.org/0000-0002-9470-7714
authors.initials: E
authors.lastname: Elliot
authors.forename: Cathy
authors.identifier: http://orcid.org/0000-0002-6734-8074
authors.initials: C
authors.lastname: Chabot
authors.forename: Janine
authors.identifier: http://orcid.org/0000-0002-3550-2970
authors.initials: J
authors.lastname: Farrell
authors.forename: Amanda
authors.identifier: http://orcid.org/0000-0002-8802-5944
authors.initials: A
authors.lastname: Bonnell
authors.forename: Shannon
authors.identifier: http://orcid.org/0000-0002-9240-9393
authors.initials: S
authors.lastname: Kopp
authors.forename: John
authors.identifier: http://orcid.org/0000-0003-1836-7225
authors.initials: J
authors.lastname: Andruschak
authors.forename: Jean
authors.identifier: http://orcid.org/0000-0002-4616-3556
authors.initials: J
authors.lastname: Shoveller
authors.forename: Gina
authors.identifier: http://orcid.org/0000-0001-5783-4493
authors.initials: G
authors.lastname: Ogilvie
keywords: Internet; health care delivery; health services research; intervention studies; sexually transmitted diseases; testing