A self-testing pilot program in Alberta allowed individuals to test for sexually transmitted and blood-borne infections (STBBIs) at home without visiting a clinic. Program participants completed an online intake questionnaire and then received a personalized test kit based on their self-reported sexual behaviours (e.g., types and sites of sexual activity). Test results were delivered via text message or email, and participants with positive results were offered follow-up linkage to care. A recent study found high acceptability and feasibility among participants who used the fully remote STBBI care pathway. Of the 156 people who completed the online self-enrolment, 43.0% (67 participants) returned their testing kits. Nine percent of these participants (six people) received new positive test results for an STBBI, and all were connected with appropriate treatment in a timely manner.
Program description
The fully remote, at-home STBBI self-testing program was designed to allow individuals to complete the entire testing process — enrolment, specimen collection, result retrieval and follow-up linkage to care — without attending a clinic in-person. Participants were recruited both online and in-person, primarily through the Centre for Sexuality (CFS) in Calgary, Alberta.
All participants self-enrolled for the program via a secure web-based platform that contained consent forms and an intake questionnaire connected to a secure server. Participants were eligible to participate if they were: residents of Alberta, aged 16 years or older and able to provide written informed consent. Upon online self-enrolment, participants completed a detailed intake survey collecting demographic information (e.g., age, sex, gender, sexual orientation), sexual history, STBBI testing history and perceived barriers and stigma related to sexual health care. The data from this intake survey informed the creation of customized, behaviour-based test kits tailored to each individual’s reported types and sites of sexual activity.
Personalized kits included:
- instructions (paper and online via QR code)
- swabs (e.g., throat, rectal, vaginal) and/or urine containers for bacterial STBBI testing (chlamydia and gonorrhea)
- a finger-prick dried blood spot (DBS) collection kit (e.g., lancet, DBS cards) for HIV, hepatitis C and syphilis testing
- prepaid and prelabelled return packaging and envelopes
- contact information for study support
After the intake survey was completed, kits were mailed the next business day and could be self-collected at home or, if preferred, at the CFS. All materials were prelabelled with a unique de-identified participant identification label to ensure privacy and traceability.
Participants returned their samples using prepaid tracked mail envelopes to the appropriate laboratory for testing (i.e., local laboratory for bacterial STBBIs and the National Microbiology Laboratory in Winnipeg for DBS tests).
Participants chose whether to receive their results via secure text message or email. Negative results were automatically generated and sent through a secure server. Positive or inconclusive results were disclosed directly by a trained research team member with clinical expertise. For participants who tested positive (particularly for HIV, hepatitis C or syphilis), the team accessed the participant’s provincial electronic health record to determine if the case was new. All participants with new or untreated infections were directly contacted and connected to appropriate community-based treatment and support services.
Results
Between February 2023 and March 2024, 156 participants enrolled in the program by completing an intake survey and receiving a kit (three individuals used the program more than once). The average age of participants was 37.3 years, and the majority identified as members of the 2SLGBTQ+ community.
Among the 156 participants:
- 39.7% self-identified as men, 34.0% as women, and 24.4% as gender-fluid, non-binary/non-conforming, queer or two-spirit; 1.9% chose not to answer
- 38.5% were single and 44.2% were in an open relationship
- 70.5% reported having one to five partners in the past year, with 10.9% reporting more than 10 partners
- of the participants who had a primary care provider, 40.0% were somewhat or extremely uncomfortable discussing sexual health with them
- nearly half (46.8%) reported dissatisfaction with existing STBBI testing and treatment services
More than half the cohort (55.8%) reported using condoms less than 50.0% of the time and almost one-third (32.1%) reported no condom use. Fourteen percent (22 participants) reported having an STBBI in the past year while 40.4% (63 participants) reported they had either had no prior STBBI testing or had not accessed testing for over 12 months.
Of the 156 people who enrolled, 43.0% (67 participants) completed and returned their test kits. Eight percent (five participants) received a positive result for chlamydia or gonorrhea. Nine percent (six participants) received a positive test for HIV, hepatitis C or syphilis. Of the six people with previous positive tests, three had previously tested positive for HIV, two for syphilis and one for hepatitis C. One participant of this group was co-infected with HIV and syphilis. One participant was newly diagnosed with syphilis. All participants with new diagnoses were linked to a community-based clinic for treatment.
Participants who completed and returned their test kit reported that they were satisfied with online testing (median score: 4/5; 1 = extremely dissatisfied; 5 = extremely satisfied) and indicated a high likelihood of reusing the self-testing program (median score: 7/7; 1 = not likely at all; 7 = very likely). Participants reported satisfaction with the communication of results and the user-friendly elements of the urine and swab collections. Participants most commonly reported challenges with DBS blood sampling, with 37.3% reporting difficulties (e.g., difficulties obtaining adequate blood samples to fill the circles on the sample card). There was positive feedback from participants about the ease of use, the clarity of the instructions, convenience and the reduction of stigma. There was negative feedback about technical issues (e.g., accessing the printed QR code) and confusion about labelling.
What does this mean for service providers?
Findings demonstrate that a fully remote, at-home STBBI testing approach is acceptable in a Canadian context — especially among people who have previously faced barriers to care because of stigma, discomfort with their healthcare providers and systemic gaps. Findings suggest that remote STBBI testing platforms may be an important tool to complement traditional services and may play a role in reducing testing inequities and reaching underserved populations. It may be useful to explore the feasibility of integrating similar models as part of a hybrid testing strategy to expand reach and inclusivity and partnering with organizations reaching underserved populations (e.g., organizations serving 2SLGBTQ+ communities).
Related resources
At-home STBBI testing: The TakeMeHome program – CATIE article
CATIE statement on the HIV self-test as a highly effective tool for increasing uptake of testing in Canada – CATIE statement
Medicine Bundle for HIV self-test kit distribution – CATIE case study
Implementing HIV Self-Testing – CATIE practice-based guidance document
Reference
Christensen BL, Rytz CL, Black JE et al. Comprehensive at-home sexually transmitted and blood borne infection (STBBI) testing program: a pilot study. International Journal of STD & AIDS. 2025;0(0). Available from: https://doi.org/10.1177/09564624251371793