Grant: Doctoral Research Award - PA: Patient-Oriented Research - Biostatistics

In British Columbia, sexually transmitted infections (STIs) are distributed unequally across the population, with youth (15- 24 years of age) bearing a significant burden of infection. Undiagnosed and untreated infections often lead to serious reproductive sequelae and/or opportunistic co-infections (e.g., HIV). Interventions involving active case finding and early treatment of infections are priorities for public health efforts. One population-level intervention provided by the BC Centers for Disease Control (BCCDC) is Internet-based testing or iTest, which aims to improve STI/HIV testing amongst youth and other groups that experience high rates of STI/HIV. When users access iTest, the website recommends tests based on a risk score for STI/HIV risk and then provides appropriate laboratory requisitions. The purpose of the proposed research is to develop, refine, test and validate a practical risk-scoring (or prediction) tool to support the continuum of potential uptake or scale-up of iTest. This risk-scoring tool will be comprised of a set of selective screening criteria which will be valuable for minimizing costs, targeting testing to higher risk individuals, increasing the probability of detecting infection among asymptomatic men and women, and reducing the unnecessary testing of those without infection. The proposed study aims to: (1) Develop the STI risk-scoring tool that will be used in iTest; (2) Assess the capacity of the risk- scoring tool to adequately discriminate between those who are infected and those who are not; and (3) Determine the utility of the risk-scoring tool and iTest's 'fit' for province-wide scaling up. Using multivariable analysis, the risk-scoring tool will be developed from data collected at the largest publicly funded sexual health clinic in Vancouver between 2001 and 2010 (n=76,000). The validity or usefulness of the risk-scoring tool will be evaluated in two additional clinical settings in Vancouver.