Implementing a Web-Based At-Home STD Testing Service in Alaska - Reaching Rural Communities and At-Risk Populations

Background: Alaska has the highest rates of Chlamydia in the U.S. and dramatic increases in gonorrhea.  Alaska Native people, women and youth (age 15-29) are disproportionately affected.  Alaska Native health organizations have jurisdictions over large geographic areas, containing small isolated communities where a perceived lack of confidentiality and privacy is an identified barrier to accessing health care. 

Objectives: To provide a discrete and reliable STD testing alternative that increases screening among at-risk populations.

Methods: Alaska Native Tribal Health Consortium (ANTHC) has partnered with the “I Want the Kit” program (IWTK).  This partnership is the first established with a tribal health entity.  Persons can request a no-cost test online.  The at-home testing kit is mailed in an unmarked shipping envelope.  After collection, the kit is sent back in a prepaid envelope for testing.  Results from Alaska are reported to ANTHC which is responsible for provider of record services.  Implementation of this public health initiative requires coordination between tribal, state, federal and private health groups.

Results: Thus far, 264 genital and rectal kits were requested from all regions in Alaska.  21% of kits requested have been returned for testing.  Genital swab kits are returned at higher rates 23% than rectal swab kits (14%).  The return rate is higher in females (24%, Male 17%).  Although the rate of positive cases is low (<2%), several persons have self-identified as high risk.  The program has been able to follow-up with every test result; providing appropriate intervention and treatment referral services. 

Conclusions:  This web-based STD testing option continues to address the perceived lack of confidentiality and privacy and increases access to testing overall, while targeting at-risk populations in Alaska.

Implications for Programs, Policy, and Research: Adaptation of IWTK in Alaska may provide a model for targeting at-risk and less-accessible populations, especially in rural and tribal communities.