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Abstract

Introduction: Digital interventions for sexually transmitted and blood-borne infections (STBBI) testing are one strategy to overcome barriers to accessing provider-based testing. Despite evidence of overall effectiveness, these interventions might replicate existing health inequities. Exploring awareness of services as an implementation outcome can assist in understanding differential uptake by potential users, yet few studies have assessed service awareness. GetCheckedOnline is a digital intervention for STBBI testing in British Columbia (BC), Canada. This study evaluates awareness of GetCheckedOnline in communities where it is available outside Vancouver from a health equity perspective. Methods: From July to September 2022, a survey evaluated awareness, reported use and intention to use GetCheckedOnline in Kamloops, Kimberley, Maple Ridge, Nelson and Greater Victoria, BC, using online and in-person recruitment and oversampling of populations known to face barriers to testing. The implementation outcome of awareness was analyzed through Directed-acyclic graphs (DAG) informed logistic regression modelling to examine differences according to age, gender identity, race/ethnicity, sexual identity, educational attainment, and income. Intersections between gender and race/ethnicity and sexual identity and ethnicity were also studied. Results: The final sample included 1,658 participants, of whom a large proportion comprised members of equity-owed populations. Overall awareness was 36%, with 56% of those aware having used the service (20% of the total sample). A higher likelihood of awareness was found in participants identifying outside the man/woman gender binary, transgender participants, non-heterosexual people, Indigenous individuals and People of Color. A lower likelihood of awareness was found in the lower income group and people aged outside the range of 25 to 29 years. Discussion: This health equity analysis showed that the overall proportion of 1 in 3 people surveyed being aware of the service is not equally distributed in the communities studied. The pattern of awareness distribution in the sample, in some cases, favoured equity-owed groups, while other observed differences favoured more privileged groups. These findings can provide guidance for service promotion, including the identification of populations for whom it is necessary to evaluate the appropriateness of GetCheckedOnline to ensure the service can be used to overcome barriers and meet population testing needs.