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Background: National data estimates that STD testing among young adults remains low, despite high-risk behavior. University health settings are an ideal location for innovative testing methods; self-collected vaginal swabs (SCVS) are cost effective, more sensitive than urine, and easier to process/transport than traditional clinician-obtained specimens. However, research is limited on the acceptability of self-testing/SCVS and its effect on testing uptake.
Methods: To assess acceptability and uptake of SCVS (urine and self-collected vaginal swabs), we conducted a brief self-administered survey of students accessing a large US-based university health center from January – December 2015. The survey (PDA-based, Qualtrics) assessed student demographics, reasons for testing, and satisfaction with the self-testing option. The cost for CT/GC testing was $30.
Results: Overall, 18.8% (825/4391) of students opted for the self-test option, of which 189/825 completed the survey. Of students surveyed, 63% reported that their main reason for testing was: “I had unprotected sex and wish to get tested.” In the past year, 44% had 2-3 sex partners (vaginal or anal intercourse) and 42% reported 4 or more partners. Ease of testing/no appointment needed was the main reason for choosing SCVS (69%). The majority were very satisfied with the self-test option and likely to use the service again (82%). Among students choosing self-tests, positivity was 11.8% (11.9% female, 11.6% males) compared to 6.7% positivity (4.7% female, 12.4% male) in clinician-collected tests during 2015. Since implementation of the self-test option (2013 baseline), the health center has seen an 18.1% increase in overall STD testing and a 44.6% increase in the detection of positive cases.
Conclusions: Self-testing in the university health setting may be an efficient and effective way to provide STD testing for students, and may increase testing uptake. Multiple partners, disclosure of unprotected sex, and detected infections suggest that it is not just the low-risk worried-well presenting for testing.