Evaluation of a Statewide Online, At-Home Sexually Transmitted Infection and Human Immunodeficiency Virus Screening Program.

BACKGROUND: Innovative approaches such as online, at-home programs may address important barriers to sexually transmitted infection (STI) and human immunodeficiency virus (HIV) screening in the United States. This study evaluated the first year of an online, at-home program offering HIV and triple-site (urogenital, rectal, and pharyngeal) gonorrhea (GC) and chlamydia (CT) testing in Colorado. METHODS: Test Yourself Colorado (TYC) is an online, at-home program that provides free mailed HIV tests and/or GC/CT tests to Colorado adults. Program use and outcomes between 1 June 2021 and 31 May 2022 were analyzed. RESULTS: A total of 1790 unique clients utilized TYC. Of 1709 clients who ordered HIV tests, 508 (29.7%) were men who have sex with men (MSM), and 41.3% (210/508) of these clients reported having never been tested for HIV before or were not tested in the prior year. Hispanic clients had lower STI test return rates (37.1%; 134/361) compared with non-Hispanic clients (45.9%; 518/1128) (P = .003). Positive STI tests were identified in 9.6% (68/708) of clients. Positive STI tests were more common in MSM clients (15.7%; 34/216) compared with all other sexual orientations (6.9%; 34/492) (P < .001). STI treatment was confirmed in 80.9% (55/68) of clients. CONCLUSIONS: The TYC online, home testing portal is a scalable tool that reaches clients at risk of STIs and HIV and navigates those with positive STI tests to treatment. HIV/STI home testing programs need to further assess and address utilization and outcomes for disparities by race and ethnicity to assure programs equitably benefit all at-risk communities.

Effects of palatability and learned satiety on energy density influences on breakfast intake in humans.

The present report explored firstly how palatability modified the effects of energy density (ED) on short-term food intake and changes in rated appetite within a single test meal, and secondly how repeated consumption altered these relationships. Experiment 1 contrasted disguised high (HED) and low (LED) versions of a food presented in bland and palatable forms. Mass consumed varied as an interaction of palatability and ED, with subjects eating least of the bland/HED version, suggesting some un-learned satiating effects. No such compensation for ED was seen in the palatable/HED condition, and overall energy intake increased with ED. Palatability had the expected stimulatory effect on appetite, but rated hunger decreased more rapidly as a function of energy consumed in the HED conditions. Experiment 2 introduced novel distinctive flavours to examine whether repeated experience of palatable HED and LED versions resulted in learned satiety. Participants ate the same mass of LED and HED versions on first exposure, but after two training days with each food, where they consumed a fixed amount, they subsequently ate a greater mass of the LED version, consistent with learned satiety. Increased intake was accompanied by a slower rate of decline in hunger in the LED condition. Despite these changes, energy intake remained higher with the HED version. Liking for the LED version was greater than the HED version at the end, possibly due to mild aversive qualities of eating a fixed portion of the HED food during training. Together these data suggest that energy density is the major determinant of short-term energy intake in the absence of orosensory cues predictive of energy differences, but that learning of flavour-energy associations can, to some extent, allow short-term energy consumption to be regulated.