Health Equity Analysis of Awareness and Use of GetCheckedOnline, British Columbia's Digital Intervention for Sexually...

Digital sexually transmitted and blood-borne infection (STBBIs) testing services are used to improve testing access, but might replicate existing social inequities. Previous research has shown that the digital STBBI testing service GetCheckedOnline has improved access to testing in British Columbia (BC), Canada. As part of the program's continuous evaluation, we examined awareness and use of the service in 5 urban, suburban, and rural communities where the program has expanded.

This study aimed to determine if social location is associated with differences in awareness and use of the service in 5 communities outside Vancouver, BC.

From July to September 2022, we conducted a cross-sectional survey recruiting (in-person and online) sexually active people aged 16 years or older in 5 urban, suburban, and rural communities where GetCheckedOnline had sample collection sites available at the time. We examined differences in awareness and use by age, gender identity, sexual identity, race/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework.

Of the 1658 participants (n=1058, 63.8% in-person and n=600, 36.2% online), 35.3% (586/1658) were aware of GetCheckedOnline and 19.5% (324/1658) had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (>38 years: awareness odds ratio [OR] 0.23, 95% CI 0.17-0.32; use OR 0.19, 95% CI 0.12-0.28; <25 years: awareness OR 0.39, 95% CI 0.28-0.53; use OR 0.28, 95% CI 0.18-0.41). Awareness and use were also lower in the lowest income group compared to the highest (awareness OR 0.39, 95% CI 0.24-0.65; use OR 0.36, 95% CI 0.20-0.65). Awareness and use were higher among genderfluid, genderqueer, and nonbinary participants compared to men (awareness OR 2.27, 95% CI 1.63-3.18; use OR 1.97, 95% CI 1.36-2.84), transgender compared to cisgender participants (awareness OR 2.17, 95% CI 1.54-3.06; use OR 2.15, 95% CI 0.46-3.13), and nonheterosexual compared to heterosexual participants (awareness OR 2.37, 95% CI 1.89-2.97; use OR 2.53, 95% CI 1.91-3.38). People of color had higher awareness and use vs White participants (awareness OR 1.74, 95% CI 1.34-2.26; use OR 2.01, 95% CI 1.48-2.72). Indigenous participants had higher awareness than White participants (OR 1.65, 95% CI 1.19-2.20) but no difference in use. Women had similar awareness but lower use compared to men (OR 0.68, 95% CI 0.50-0.92).

GetCheckedOnline is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.