The latest CDC numbers show that Washington, D.C. ranks 30th of all U.S. metropolitan areas in HIV transmissions and the same study showed 2.4 million sexually transmitted infections (STIs) across the U.S., with some STIs like syphilis increasing by 254 percent! And while COVID-19 has garnered the lion’s share of media attention, the new CDC report indicates it is just one of many public health crises facing the U.S.
Over the course of the pandemic, we’ve learned that COVID-19 and STIs share a common weapon in decreasing transmission rates — increased access to testing. With COVID-19, health professionals understood the need for at-home testing and as a result they have mailed out millions of free, at-home tests to Americans and we’ve seen a rapid decline of transmissions as a result. The same is not true for STIs. Patients have always been required to go into a lab or clinical setting in person for STI testing and as a result, access to testing has long been a primary barrier to reducing STI transmission rates.
But all of that is changing.
The combination of scientific breakthroughs and modern platform integration technology have made it possible for self-collected specimens to provide validated test results to be followed up by clinical care. These developments are eliminating barriers like access to in-person testing and discomfort due to discrimination or stigma, which often accompanies in-person STI testing. Many point to these barriers as the primary reason for America’s high transmission rates. While it is possible for D.C. residents to forego in-person visits to a lab, we still have a long way to go to get medical practices and insurance companies to amend processes to support self-collected, at-home STI testing.
We know that more testing is needed if we are to reverse rapidly escalating rates of STI transmission. We must creatively overcome every barrier to testing access if we are to be successful. As an infectious disease physician and after 35 years working in the HIV and STI space, I have joined a movement committed to eliminating barriers to testing and care; in fact, a silver lining of the COVID pandemic has been the expansion of policy, the science, and the patient embrace of at-home testing. COVID has demonstrated that at-home tests unlock access to testing and thus facilitates reduction of disease transmission. For instance, a recent analysis by Molecular Testing Labs and Q Care Plus demonstrated that among more than 5,000 patients, 84% preferred undertaking PrEP-related STI and HIV testing at home. This is authentic patient-centered testing and care.
COVID-19 has taught us many lessons, top among them that increased testing is among the most effective ways to address otherwise uncontrolled spread of infectious diseases. I can say without a doubt that laws encouraging and requiring coverage of innovative and proven testing approaches will interrupt forward transmission of infections and save lives, particularly among those with limited access to care and who are otherwise disenfranchised by our healthcare system.
Federal agencies should follow the lead of state and local governments who set aside money to promote the availability of and access to at-home STI testing and attendant treatment. Insurance companies and payors also should rapidly implement streamlined reimbursement practices to ensure these tests are covered and that patients are not being charged in error, which inhibits access to testing and care.
My career was informed by lessons in epic public health crises like HIV and the COVID-19 pandemic. Our data demonstrate that expanded, affordable access to at-home self-collected testing can overcome stigma and reduce infection spread. We have the tools to identify and eliminate STIs in our communities. We should use them.
Dr. Christopher Hall serves as the Medical Director of Clinical Affairs at Molecular Testing Labs, pioneering self-collected STI testing. He began his 30-year career in HIV/STI policy, research, care and prevention working with the National AIDS Network in D.C. and later the National Coalition of STD Directors and the California Department of Public Health.