Perceived benefits, barriers, and health system consequences of introducing new models of online sexually transmitted and blood-borne infection testing in Ontario, Canada.

BACKGROUND: Internet-based testing services for sexually transmitted and blood-borne infections have increased in prevalence and altered the testing landscape and testing behaviours in many jurisdictions. Our objective was to understand how system partners perceived the possible benefits and drawbacks of adapting and implementing an online testing program like GetCheckedOnline which was already operating in British Columbia, Canada, into a new provincial context where it did not exist. METHODS: We conducted in-depth interviews and focus groups with sexual healthcare providers, program managers and developers, and other public health professionals with expertise in sexually transmitted infections testing (N = 41) in Ontario, Canada. Our interview questions were part of a larger study focused on improving equitable access to sexually transmitted infections testing. Transcripts were transcribed verbatim and analysed using NVivo software following grounded theory. RESULTS: We created a conceptual figure to chart tensions from participant accounts onto a model of GetCheckedOnline. We describe five key tensions in the accounts of our participants to elucidate perspectives on the possible benefits and barriers/concerns of implementing a digital testing model like GetCheckedOnline in another province: (1) access, (2) privacy, (3) co-ordination/communication, (4) agency, and (5) health system impacts. We map these five tensions across the core elements of the online testing program (i.e., from creating an online account, completing an assessment, and submitting specimens to getting results and engaging in repeat testing). CONCLUSION: Our analysis elucidates the multiple advantages that online testing modalities may provide for service users as well as substantive barriers and concerns perceived by health system partners, including the potential (unintended) consequences and paradoxes of introducing digital sexually transmitted infections testing.