Americans Attitudes Towards Sexually Transmitted Infections (STI) Testing. Analyte Health, Inc. s Annual Survey: 2018

Transcription

1 Americans Attitudes Towards Sexually Transmitted Infections (STI) Testing Analyte Health, Inc. s Annual Survey: 2018

2 Key Findings STIs are steadily on the rise in the U.S., with hot spots regularly developing around the country About 30% of sexually active respondents get clinically recommended STI tests at their primary care physician s office More than 40% of sexually active respondents favored an online solution for STI testing About Our Survey YEARS OLD $$$ 1,030 RESPONDENTS Respondents had to be between 18- to 75- years-old and reside in the United States to participate in the survey The surveyed population included representatives from all regions of the United States and from all income brackets One thousand thirty respondents completed the survey in March 2018 Was demographically representative of the U.S., based on the latest available information from the U.S. Census Bureau Results presented in this report are from an online, market research survey developed by Analyte Health and conducted in March, Respondents matched overall U.S. population in distribution of age, gender, geography, sexual orientation and income.

3 Overview Analyte Health, which has facilitated over 2.5 million test results nationwide through its online consumer health solutions, published for the first time its internal annual survey of attitudes towards Sexually Transmitted Infection (STI) testing. When combined with actual reported infection rates, the survey results offer unique insights into the state of sexual health in the United States, and possible solutions to combat steadily rising rates of infection. The prevalence of STIs has steadily increased over the last 20 years. Some communities are now facing the reversal of many decades progress in reducing the occurrence and impact of diseases like syphilis, gonorrhea, and chlamydia. STIs often do not result in immediate symptoms, meaning widespread STI testing and early treatment are critical in preventing the spread of STIs. Key findings of the annual Analyte Health survey include that only 45% of sexually active, non-partnered respondents carry out regular, annual STI screening. This stands in stark contrast to medical guidelines that suggest 100% of this population undergo regular testing. Additionally, less than 30% of sexually active respondents received STI testing from their primary care physician, a consequence of the fact that almost half of Americans don t annually see a primary care physician, and that STI testing is discussed less than half the time when such visits occur. Encouragingly, the survey indicates that public health clinics, Planned Parenthood clinics, and online solutions play a useful and crucial role in providing access to STI tests for patients that are not well-connected to a primary care physician. In particular, online solutions are favored by more than 40% of sexually active respondents, a function of confidentiality and convenience. Yet not that long ago, gonorrhea rates were at historic lows, syphilis was close to elimination, and we were able to point to advances in STD prevention, such as better chlamydia diagnostic tests and more screening, contributing to increases in detection and treatment of chlamydial infections. That progress has since unraveled. Gail Bolan, MD, U.S. Centers for Disease Control & Prevention 1

4 STIs: An Overlooked Public Health Emergency More and more Americans are being diagnosed with STIs such as chlamydia, gonorrhea, and syphilis. Prevalence rates for all three have steadily increased over the past two decades (see Figure 1) despite advances in diagnostic tests and the expansion of health insurance. In 2016, the CDC released its updated Sexually Transmitted Disease Surveillance Report, estimating that 20 million Americans contract a new STI each year and over 110 million Americans currently have an STI. 1 Even in the past year, local public health officials have observed alarming spikes in STI prevalence (see Figure 2). The Milwaukee Department of Health reported a 29% increase in new cases of syphilis and a 12% increase in new cases of gonorrhea between 2016 and Alaska s Department of Health and Social Services recently reported a spike in syphilis cases. Only a quarter of the way through 2018, Alaska has already surpassed the number of cases they diagnosed in Though treatable, especially if caught early, most STIs are asymptomatic, meaning most people have no physical indication that something is wrong. This poses a serious challenge to curtailing the rise in STIs and underscores the Figure 1. Growth in STI Prevalence (Cases/100,000) Syphilis Gonorrhea Chlamydia 2

5 Figure 2. Spikes in STI Transmission Reported in the Last 12 Months Gonorrhea Chlamydia Syphilis HIV importance of regular STI testing. Untreated STIs can have serious health consequences, including ectopic pregnancies, infertility, increased risk of HIV infection, and more. Getting Americans tested for STIs on a regular basis is critical to catching and treating infections and preventing their continued spread. The longer we wait to respond to current trends, the more difficult and expensive the public health battle will become. STDs Hit All-Time High for Third Year in U.S. New York Post, Tuesday, October 31, 2017 HIV Rates Rise in at Least Two U.S. Hot Spots CNN, Friday, March 16, 2018 Untreatable Super Gonorrhea Case Could Be Tip of the Iceberg Fox News, Monday, April 2,

6 Analyte Health s Annual Survey on Americans Attitudes Towards STD Testing Regular STI screening and early treatment is critical to decreasing STI prevalence and preventing serious health consequences. However, only a fraction of the recommended population is receiving regular STI screening. For example, sexually active women ages are one of the populations most susceptible to chlamydia infection. Yet national claims data from commercial and Medicaid payors suggests that only 40 50% of this population receives a recommended annual screening for chlamydia. 4 Analyte Health surveyed 1,030 Americans in March 2018, to better understand attitudes towards STI testing, especially why Americans do or do not seek out testing. At the highest level, we found only 45% of sexually-active respondents who do not have a long-term partner receive an annual STI test. That compares to the latest clinical guidelines that 100% of such a population be tested regularly. Education may be the biggest barrier to increasing the rate of regular STI testing. In our survey, 50% of respondents who had two or more sexual partners in the last 12 months reported that they, Don t need regular STI screening. This was the leading reason why sexually active, nonpartnered adults did not seek out an STI test, and respondents cited this rationale 2 3 times more often than most other options (see Figure 3). The second leading reason, at 33% of respondents, was not being able to afford a test. This too may be an education issue given most insurance companies cover STD tests as Figure 3. What Prevents You From Seeking Regular STI Testing? Respondents With Multiple Sexual Partners Don't Need It 49 Too Expensive 33 No Time 26 Confidentiality 19 Doctor Doesn't Ask Unsure Where to Go Other % 20% 30% 40% 50% Source: America's Attitudes Towards STI Testing, Analyte Health's Annual Survey:

7 The resurgence of syphilis, and particularly congenital syphilis, is not an arbitrary event, but rather a symptom of a deteriorating public health infrastructure and lack of access to health care. Gail Bolan, MD, U.S. Centers for Disease Control & Prevention preventative services and that community health centers and Planned Parenthood clinics often offer subsidized or free testing options. When Americans do get an STI test, it is typically part of an annual checkup with their primary care physician (PCP) or gynecologist (OB/GYN). In our survey, around 80% of respondents who had received an STI test did so at their physician s office. The 2016 CDC Sexually Transmitted Disease Surveillance Report supports this finding, listing private physicians as one of the top reporting sources for STI cases over the last 10 years. However, according to the CDC, only about 50% of Americans visit a PCP or OB/GYN on a yearly basis, and this rate has declined from about 65% in This leaves a significant population of Americans without a relationship with a PCP and this often-used channel for regular STI testing. This is particularly true for younger Americans who are also more likely to have STIs. Our survey numbers are largely consistent with the CDC s numbers, with only 57% of 18- to 29-year-old and 63% of 30- to 44-year-old respondents reporting having visited a primary care physician in the last two years. Further, our survey suggests that even when people do go to a primary care visit, it is not guaranteed that the physician will discuss STI testing. Fifty-three percent of sexually-active, non-partnered survey respondents reported that they did not discuss sexual health or STI testing with their primary care physician during their office visit. This reinforces the need for channels other than primary care physicians to remind Americans of the risk of STIs and to provide convenient access to STI testing. Another commonly cited barrier to seeking out STI testing is confidentiality concerns. Our survey respondents reported confidentiality as the most important aspect of an STD testing methodology after accuracy (see Figure 4). They believe it is more important than convenience, affordability, or the speed of results. A different survey conducted by the CDC found that confidentiality concerns were a key deterrent to STI testing among 15- to 25-year-old Americans. 6 Survey respondents were not only nervous about family or friends discovering they had been tested but they were also nervous about reporting sexual activity to and/ or requesting a test from their physician. 5

8 Figure 4. What Factors Are Most Important When Selecting an STI Testing Method? Accuracy Confidentiality Accepts Insurance Convenience Affordability Speed of Results % 20% 40% 60% 80% 100% Very Important Important Neutral Not Important Not at All Important Source: America's Attitudes Towards STI Testing, Analyte Health's Annual Survey: 2018 This underscores that sexual activity is a sensitive topic and can be difficult to discuss face-to-face, even with a trusted physician. In our survey, we investigated what populations sought out STI testing from sources other than their physician, including public health clinics, Planned Parenthood clinics, or an online solution. First, and unsurprisingly, respondents who did not report an annual PCP visit, were nearly twice as likely to have received an STI test from a clinic or online solution. This was true even for respondents who were seeking out annual STI screening, and it reemphasizes the role of clinics and other STI testing sources for populations not connected to the healthcare system. Second, respondents were more likely to turn to a clinic or an online solution if they were seeking testing due to an immediate need rather than as part of an annual, regular STI screening. Meaning they felt the need for an STI test after a specific encounter, after being notified by a past partner, or because they were experiencing symptoms. Forty-seven percent of respondents with immediate testing needs favored a clinic or online solution. The results above underscore the critical role Planned Parenthood and public health clinics play in providing access to STI testing. Planned Parenthood alone administered nearly 4.5 million STI tests in However, public health initiatives are facing continued funding and political 6

9 uncertainties. In its surveillance report, the CDC expresses alarm at this trend, citing that, in 2012, 52% of local and state STI testing programs faced budget cuts. According to the CDC and other sources, clinics providing STI screening services are being pressured to do more with fewer resources and a smaller footprint. Our survey, along with other cited studies, suggests several takeaways on American s attitudes towards STI testing: lmany sexually-active, non-partnered Americans do not believe they need regular testing. This may be the greatest challenge that faces the public health community. lwhile annual primary care visits can reinforce the need for regular STI screening, around 40 50% of Americans do not see their primary care physician on an annual basis. When they do, they may find it difficult to discuss STI testing and sexual activity face-to-face with their physician. lpublic health clinics, Planned Parenthood clinics, and online solutions play a vital role in providing STI testing for populations that are not well-connected to a primary care physician and/or feel an immediate, urgent need for an STI test. Using Online Solutions to Expand STI Screening Our survey found a willingness among respondents to consider online solutions the next time they seek out an STI test. Forty-five percent of sexually-active (>1 sexual partner in last 24 months), either agreed or strongly agreed that they would prefer it over other testing methodologies (see Figure 5). Interestingly, respondents across age groups were nearly equally interested in an online solution. These findings suggest that online solutions can help increase STI screening rates by overcoming some of the barriers mentioned above. Medical professionals generally agree that solutions should not replace the regular STI screening that is happening as a part of annual primary care visits. However, since only 40 50% of some at-risk populations are receiving regular STI Figure 5. Compared to Other STI Testing Options, Would You Prefer an Online Solution? 18% 29% 29% 10% 14% Strongly Agree Agree Neutral Disagree Strongly Disagree More than 40% of respondents favored an online solution for STI testing Source: America's Attitudes Towards STI Testing, Analyte Health's Annual Survey: Respondents filtered to include only those with >1 sexual partners in the last 24 months. 7

10 What Is an Online Solution for Testing? Physician-ordered STD test facilitated via website or call center Results delivered via secure website, reviewed with clinician, as needed Sample provided at walk-in lab or via mail-in kit Sample analyzed and lab results reviewed by physician screening, patients desire additional tools and tactics to receive testing. Our research suggests patients desire for online STI testing solutions is fueled by several factors. First, online testing is easily actionable. If Americans do not feel that STI testing is particularly urgent or needed at all, it is imperative to make it as easy as possible to respond to a cue to get tested. Clicking a link and ordering an online test is a lot easier for many Americans today than scheduling an appointment to see their physician or carving out time to visit a clinic. A recent study in the U.K. suggests online solutions could increase STI screening rates for just this reason. In the study, researchers sent a group of 16- to 30-year-old, sexually active adults a list of seven local clinics where they could receive an STI test. The researchers sent a different group of participants a message with a link to order an at-home STI testing kit. The results: twice as many participants completed an STI test in the online group (50%) than in the clinic group (26%). 8 Second, online testing can alleviate concerns about confidentiality. Just showing up in a public health clinic or STI screening center can result in some level of disclosure or implied disclosure of needing STI testing. Further, admitting at-risk behaviors in a live or face-to-face conversation is often very difficult, especially in situations involving infidelity or activity inconsistent with an individual s declared sexual orientation. Online, telehealth interactions provide more perceived anonymity, and they can make it easier to have uncomfortable conversations. Third, online solutions, messaging, and are the preferred communication medium for younger Americans who increasingly spend more time online. 15- to 25-year-old Americans account for 50% of new STI cases each year. This population is also less likely to have an annual primary care visit than older population groups. If this is a target population for STI testing, we should meet them online, where they spend an increasing amount of time. 8

11 Finally, online solutions are easily scalable. Public health initiatives could more easily deploy online solutions to address localized STI outbreaks. Further, online solutions can help at-capacity clinics reach more patients and/or reach patients in outlying areas. They can also help preserve clinic appointments for higher acuity needs rather than for simpler screening tests. STI testing campaigns partnered with online solutions may be the country s fastest way to respond to the rise in STI prevalence. A Multi-Faceted Approach to Expanding STI Screening Our survey echoes government and peer-reviewed research that demonstrates sexually Americans are not seeking out regular STI testing at rates that would promote individual and public health. This is particularly alarming in the face of steadily increasing STI rates. In conjunction with efforts at public policy, academic levels, moves to increase insurance coverage, and the work of Planned Parenthood and other health clinics, our research suggests digital online solutions should be used to increase STI testing rates among sexually active Americans. STIs include chlamydia, gonorrhea, HIV, syphilis, hepatitis B, hepatitis C, trichomoniasis, herpes 1 & 2, HPV, mycoplasma and ureaplasma. References 1 Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance Atlanta: U.S. Department of Health and Human Services; Scutti, Susan. HIV rates rise in at least two U.S. hot spots. CNN. March 16, Accessed online at: 3 Polk, Leroy. Alaska syphilis cases rise, first months of 2018 as high as entire year of NBC Alaska KTUU. March 16, Accessed online at: 4 National Committee for Quality Assurance. The State of Healthcare Quality Available at: ncqa.org/report-cards/health-plans/state-of-health-care-quality. Accessed March 18, National Center for Health Statistics. Health, United States, 2016: With Chartbook on Long-term Trends in Health. Hyattsville, MD Cuffe, Kendra M. et al. Sexually Transmitted Infection Testing Among Adolescents and Young Adults in the United States. Journal of Adolescent Health, Volume 58, Issue 5, Planned Parenthood Annual Report. Available at: Accessed March 19, Russell, Peter. Online Kits May Boost STI Test Uptake. MedScape. December 28, Access online at: mscpedit&uac=116687by&impid= &faf=1 9

12 Study Authors Frank Cockerill, MD Dr. Cockerill currently is the Chief Medical Officer of Analyte Health. Dr. Cockerill is the past Chair of Department of Laboratory Medicine and Pathology, Mayo Clinic, and President and CEO of Mayo Collaborative Services, Inc. (MCSI)/ Mayo Medical Laboratories (MML). While at Mayo, he also carried a named professorship, the Ann and Leo Markin Professor of Medicine and Microbiology at the Mayo Medical School. Dr. Cockerill is Board Certified in Internal Medicine and Infectious Diseases (American Board of Internal Medicine) and Clinical Microbiology (American Board of Pathology). Dr. Cockerill has authored or co-authored over 150 publications in the medical literature many of which relate to diagnostic testing for infectious diseases. Dr. Cockerill s past extramural leadership positions include Chair of the Subcommittee on Antimicrobial Susceptibility Testing, Clinical Laboratory Standards Institute (CLSI), Chair, Microbiology Devices Panel of the Medical Devices Advisory Committee of the U.S. Food and Drug Administration (FDA), Board Member and Program Director, of the Association for Molecular Pathology (AMP), Director, American Clinical Laboratory Association Board; Director, Board of Scientific Counselors of the Centers for Disease Control and Prevention (CDC) and Editor, Journal of Clinical Microbiology. Ruthann Cunningham, MD Dr. Cunningham is the longest tenured member of the Analyte Physicians Group. She is board certified in emergency medicine and has been at the forefront of innovation, using technology to increase access to vital health services. She received her medical degree from Wayne State University School of Medicine and has been in practice for more than 20 years. Jeff Darragh, MBA Mr. Darragh currently is the Vice President of Strategy and Partnerships at Analyte Health. He has worked his entire career at the intersection of health and technology, having previously worked at Epic, Valence Health and Evolent Health. About Analyte Health Analyte Health is the leading health-enablement company empowering patients to acquire and understand healthcare diagnostic information as conveniently, confidentially, and cost-effectively as possible. By combining a national network of diagnostic centers, a family of online digital assets, and a national telemedicine footprint, Analyte Health is helping thousands of consumers every week, and has facilitated more than 2.2 million patient tests via at-the-lab tests or at-home collection kits. Analyte Health works directly with consumers as well as partners with telemedicine groups, pharmaceutical companies, community health centers, diagnostic companies, and others to drive clinical compliance and responsible health awareness. To learn more visit analytehealth.com. 328 South Jefferson St., Suite 770, Chicago, IL info@analytehealth.com 2018 Analyte Health. All Rights Reserved.