STDTest.org - free, accessible, online STD/HIV testing

STDTest.org - free, accessible, online STD/HIV testing

United States
Project Summary
Elevator Pitch

Concise Summary: Help us pitch this solution! Provide an explanation within 3-4 short sentences.

In response to encouraging Americans to know their HIV status, public health professionals have initiated a massive awareness campaign via traditional media. This awareness does nothing if there are no accessible and affordable places to be tested. Barriers that are keeping people from finding out their HIV and STD status include:
-- Long waits, inconvenient hours, and brusque service at public health clinics
-- Denied service at public clinics (not in a high-risk group)
-- Don't want to discuss risky sexual behavior with their regular doctors
-- Incomplete insurance coverage for "preventative" STD testing at private doctors' offices
-- High fees at private, online test sites

STDTest.org uses the Triple A engine (accessibility, anonymity, affordability) of the Internet to meet everyone's needs in regards to STD/HIV testing. The site will address the issues currently keeping sexually active people from getting tested by providing a secure, confidential online environment where people can learn about STDs and download lab slips at any time of day or night; bypass an office visit and simply take their lab slips to laboratories that are open flexible hours (including weekends); be finished at the lab in 5-10 minutes, and receive results for no charge online within 3-5 days via a confidential ID.

Unlike some commercial sites (eHIVtest.com), where testing can cost close to $600, all testing via STDTest.org will be free. Donations will be accepted on the site, and continued fundraising on ISIS' part will help provide continuance of service.

About You
Location
Project Street Address
Project City
Project Province/State
Project Postal/Zip Code
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Your idea
Focus of activity

Service/process

Year the initiative began (yyyy)

2004

Positioning of your initiative on the mosaic diagram
Which of these barriers is the primary focus of your work?

Health care not consumer friendly

Which of the principles is the primary focus of your work?

Simplify through technology

If you believe some other barrier or principle should be included in the mosaic, please describe it and how it would affect the positioning of your initiative in the mosaic:

This field has not been completed

Innovation
Define the innovation

In response to encouraging Americans to know their HIV status, public health professionals have initiated a massive awareness campaign via traditional media. This awareness does nothing if there are no accessible and affordable places to be tested. Barriers that are keeping people from finding out their HIV and STD status include:
-- Long waits, inconvenient hours, and brusque service at public health clinics
-- Denied service at public clinics (not in a high-risk group)
-- Don't want to discuss risky sexual behavior with their regular doctors
-- Incomplete insurance coverage for "preventative" STD testing at private doctors' offices
-- High fees at private, online test sites

STDTest.org uses the Triple A engine (accessibility, anonymity, affordability) of the Internet to meet everyone's needs in regards to STD/HIV testing. The site will address the issues currently keeping sexually active people from getting tested by providing a secure, confidential online environment where people can learn about STDs and download lab slips at any time of day or night; bypass an office visit and simply take their lab slips to laboratories that are open flexible hours (including weekends); be finished at the lab in 5-10 minutes, and receive results for no charge online within 3-5 days via a confidential ID.

Unlike some commercial sites (eHIVtest.com), where testing can cost close to $600, all testing via STDTest.org will be free. Donations will be accepted on the site, and continued fundraising on ISIS' part will help provide continuance of service.

Context for Disruption:

STDTest.org is a simple 3 step process whereby people can bypass the doctors' office in order to get tested for common STDs, including HIV, and receive their tests results online confidentially, and in a timely manner.<br>
Step One: Download a lap slip from a secure website. (Bookmark the page.)<br>
Step Two: Go to one of many local labs and provide specimens. <br>
Step Three: Get your results online within 3-5 days via a unique identifier (ID). <br>

The Centers for Disease Control and Prevention (CDC) estimates that 180,000 to 280,000 people nationwide are HIV-positive but unaware of their status. Two of the goals of Healthy People 2010 are to ensure that every American has the opportunity to get tested, and to decrease the number of people who are HIV-positive and unaware of their status. Many co-infections of sexually transmitted diseases and HIV have now been documented, as evidenced by the fact that being infected with an STD can significantly increase one's risk of giving or receiving HIV.

Public health professionals have responded to the Healthy People 2010 call to action by raising awareness about the need to get tested for HIV and other common STDs. However, even though people know that they need to get tested, they consistently run into barriers. These include medical bureaucracy, unsympathetic service provision and in some cases, high costs, and insurance hassles. STDtest.org is innovative because it meets people's needs by providing a free, confidential, nonjudgmental, and accessible way to get tested for STDs.

Delivery Model

We launched a pilot service of STDtest.org on the San Francisco Department of Public Health server in 2004, offering only syphilis testing to San Francisco residents. The service is technologically simple:
- Users enter their personal identifying information into a web-based form which generates a 9-digit unique identifier and a physician-referred lab slip for printing.
- At the end of each day, all identifying information is taken offline and stored in a stand-alone database on a dedicated server.
- User takes the lab slip to a commercial lab for specimen collection.
- Lab faxes results to health professionals. Health professionals manually enter data into a web-based database via unique identifier.
- User logs on to service, enters unique identifier and obtains test results within 3-5 days. HIV test results offered by phone.
- Health professionals follow-up with all users who test positive for any STD regarding proper treatment.

Since the pilot launched in 2004, we have conducted numerous focus groups and outreach discussions with folks on the street and determined that:
1) People don't want the service associated with the public health system (they are afraid of information in regards to their sexual behavior being compromised);
2) People want more than just syphilis testing offered - the full complement of services is preferred;
3) People want the service to continue to be free and available to all, whether they are high risk or low risk for contracting an STD, high income or low income; all ethnicities, ages, races and genders;
4) People want the home page to reflect themselves and their community via photos; and
4) People outside of San Francisco are interested in this service in their geographic area.

In 2008, we plan to move STDtest.org to its own server, and to offer an expanded menu of testing services, including syphilis, gonorrhea, chlamydia, herpes and HIV. By late 2008, we hope to expand STDtest.org to be a self-supporting, national service.

Key Operational Partnerships

We work closely with the San Francisco Department of Public Health in order to provide physician-ordered lab slips, negotiate prices of testing services with the national lab corporation (LabCorp) and to assist with data entry in regards to test results and follow-up with people testing positive. We also have a Community Advisory Board who directs the process every step of the way - from feature development, design, marketing and implementation.

Impact
Financial Model

We have seed money to expand the service from the San Francisco Department of Public Health. Once the expanded service is up and running, we intend to encourage donations from users of STDtest.org who can afford it. For comparison, a local clinic providing free STD and HIV testing services in the afternoons in the Castro neighborhood, collects upwards of $200,000 a year in donations for services provided, although they do not charge any fees up front.

What is your annual operating budget?

357K

What are your current sources of revenue? (please list any sources that are foundation grants)

The following are our organizations' sources of revenue for the more than a dozen projects we are working on:

Washington DC Department of Public Health
State of Florida, Dept. of Public Health
State of Idaho, Dept. of Public Health
State of Wisconsin, Dept. of Public Health
State of Minnesota, Dept. of Public Health
National Library of Medicine
University of Colorado, Health Sciences Campus
San Francisco Department of Public Health
Full Circle Fund (** foundation grant)
Anonymous Donors

Effectiveness

684 syphilis tests have been performed via STDTest.org. 43 people had reactive serologies, 12 people were diagnosed with a new syphilis infection and treated. The numbers for people testing online just for syphilis have moved slowly and steadily upwards launch, via word of mouth (no additional marketing funds appropriated). Because of the success of STDtest.org, the San Francisco municipal STD clinic (City Clinic) decided to offer STD testing results online from tests performed in their clinics.

Which element of the program proved itself most effective?

Helping people take care of their sexual health by providing free, confidential, accessible STD testing services online.

Number of clients in the last year?

681 syphilis tests have been performed via STDTest.org. 43 people had reactive serologies, 12 people were diagnosed with a new syphilis infection and treated. The numbers for people testing online just for syphilis have moved slowly and steadily upwards since 2004, via word of mouth (no additional marketing funds appropriated).

What is the potential demand?

Once we market the service and offer comprehensive testing services (syphilis, gonorrhea, chlamydia, HIV, and herpes), the potential grows exponentially. San Francisco City Clinic, the free municipal STD clinic, sees upwards of 500 patients a week. Considering that approximately 60% of those patients have Internet access, there is the potential for STDtest.org to serve over 15,000 people a year with proper marketing and continued word of mouth support.

Scaling up Strategy

We are currently in the scale up mode for STDTest.org. We have reached out to numerous community members to get their insight and opinions on the site, as well as conducted usability testing on the current service. We have seed money from the San Francisco Department of Public Health to move the website off of their server. Designs are being vetted by community members. Engineers are working out the details of the database structure, data transfer, and security. We are talking with other health departments about expanding into their states and counties.

Stage of the initiative:

1

Expansion plan:

We have convened a community advisory board who will meet three more times in person, and provide feedback on the model as we expand the services and take STDtest.org off the Dept. of Public Health server. Once we launch the newly designed and expanded service, we will hold a press conference, post billboards in strategic neighborhoods in the city, and print palm cards (business sized cards) to distribute at bars, clubs, gyms, restaurants and on the street with the url and tagline, "Free online STD testing services for San Francisco residents."

Once word spreads about the expanded project's success in San Francisco, we would like to partner with LabCorp to provide the same services nationally. We would then add a search for lab testing site by zip code to the website so people in the U.S. could have access to the online lab slips and their personal test results.

Origin of the Initiative

We looked at the comments cards from patients at San Francisco City Clinic between 2000-2002, held focus groups with San Francisco residents about services needed in regards to HIV and STD testing, and looked at the epidemiological trends of the then raging syphilis epidemic in San Francisco. Patient comment cards were the most telling in that there were hundreds of complaints about the long waits, the denial of service (not in a high-risk group), and the judgmental nature of the services they received in regards to STD and HIV testing and screening.
In addition, we convened a community advisory board, who told us stories of exorbitant insurance bills after "routine" STD testing, the difficulties of finding services they could trust, and the need to take down barriers, including shame and embarrassment around STD testing.

Sustainability
What are your two main challenges to finance the growth of your initiative

1) Concern that lab fees will be considerably more than donations elicited.

Financing needs: Year 1 $25,000 in marketing, $10,000 in expansion development costs, $20,000 in lab fees

How did you hear about this contest and what is your main incentive to participate?

New York Times article about grantmakers and innovative funding strategies. Our main motivation to participate is to garner support for our innovative projects, which are not usually funded by traditional grant makers and foundations.

The Story
Do you have an annual financial statement?

Yes.

Do you currently have an annual financial statement that tracks profit/loss?

Year 1 $25,000 in marketing funds, $10,000 in expansion development costs, $20,000 in lab fees
Year 5 $15,000 for continued marketing and maintenance (lab fees covered by patient donations)

Please describe the amount (and/or type) of funding you need to implement your initiative, at year 1 and at year 5.

This field has not been completed