The I Know Program: Improving Screening Using Home GC/CT Testing Kits for Women Harlan Rotblatt Los Angeles County Division of HIV and STD Programs Last Updated: June 19, 2018 uwptc@uw.edu uwptc.org 206-685-9850
Disclosures Mr. Rotblatt has no relevant financial disclosures.
Today s Presentation Brief background of the I Know program Successes and challenges Implications for STD prevention in other jurisdictions
What is I Know?
What is I Know? STD prevention program for young women ages 12-25, with: - Free APTIMA Combo 2 home collection kit for CT/GC - Website and kit materials in English and Spanish - STD clinic locator - Comprehensive STD info - Promotion of other prevention services Inspired by Johns Hopkins I Want the Kit program
A Brief History 2007: Social marketing campaign to promote testing 2009: Home testing features added: online and phone orders 2012: Tablet outreach and kiosk orders added 2013: Three more CA counties join with support from CA DPH 2014: (LAC only): Security concerns cause suspension of online orders pending: - coding alterations (completed 2015) - new server configuration (still pending)
Now in 4 CA Counties CA STD Control Branch supports I Know in Alameda, Sacramento, and San Diego Alameda Los Angeles Sacramento San Diego
Dontthinkknow.org Portal
I Know Key Elements in LAC at peak operation Order kits by: - Toll-free hotline - Online - Tablet outreach Get results by: - Toll-free hotline - Online (first public home testing program in U.S. All positives contacted and given free treatment referrals
Why a Home Test Kit for CT/GC? Going to clinic can be significant barrier to testing. Price of test is not just cost, but includes: - Actual cost (transportation, childcare, etc.) - Time and hassle of going to clinic - Privacy - Emotional implications: stigma, possible loss of relationship A home test kit reduces the TOTAL price of testing: - Eliminates time, hassle, cost of clinic visit - Enhances sense of privacy - By reducing overall price, may also reduce effect of emotional concerns
Ordering a Home Test Kit Key Steps Client orders kit online Client orders kit by phone via STD Hotline Lab tests specimen Client order stored in DTK online data base Client mails specimen to lab Kit sent to Client Client takes home test Lab sends results to DHSP Results posted on DTK website Client gets email or text notice that results are ready Client gets results online or by calling STD Hotline
The Kit: What s Inside
Instruction Brochure and Specimen Tube Label
Lab Slip Sent to client with kit Client fills in collection date Public Health Lab can use bar codes to scan client into lab database
Website Order Form
Tablet Outreach Added 2012 The tech: Samsung 7 Galaxy Tab Data plan for secure data transfer (no wifi) Pre-printed label ID numbers used for specimens Key benefit: Laser-targeting of high-risk populations and priority areas
Clients with Positive Results Positive clients given 3 steps: Get treated Get re-tested in 3 months Tell partners DPH staff track all positives Clients contacted 1 week after results posted Tried to reach all positives: 2 calls 2 emails 2 letters 2 site visits
I Know Home Test Kit Orders by Order Modality June 8, 2009 June 7, 2015 Total Orders: 9,419
I Know Overall Program Results June 8, 2009 - June 7, 2015
I Know Positivity Rates June 8, 2009 - June 7, 2015
DTK Treatment Confirmation Rate by Order Modality 2009-15
I Know Achievements Served LAC Residents: - More than 9,400 orders filled; more than 4,600 tests performed - Overall case-finding of 8.7% exceeded community and school clinics - Engaged tens of thousands of people to take action on STDs, sexual health - Media campaign significantly increased clinic testing (OR: 1.56) - Provided testing to areas with fewer clinic services (like Antelope Valley) - Anecdotal impact on routine testing and retained awareness Served Public Health: - National recognition and positive media interest - Created scalable platform to provide home testing Served Community Partners: galvanized relationships with: - Clinics - Schools - CBOs - Second Supervisorial District
Implications for STD Prevention in a Jurisdiction Near YOU Address high volume reportable STDs for which: Other resources are lacking Barriers to care (including re-testing) Tablet outreach offers unique way to serve the most vulnerable Can be used by wide range of staff Interest from diverse organizations Readily adaptable to cross-promote other services: Other testing (HIV, rectal GC, male urethral) Condoms (male and female) PrEP education and linkage Connect vulnerable populations to medical home
The Value of Home Testing to Clients in 4 Ps
Promotion
I Know in the News
Remember There s no place like home
Contact Harlan Rotblatt Division of HIV and STD Programs Los Angeles County Department of Public Health 600 S. Commonwealth Ave., 11th Floor Los Angeles, CA 90005 Email: hrotblatt@ph.lacounty.gov Tel: 213-351-1124