Empowering sexual health with self-test visual guides

Addressing the STI Epidemic

The Centers for Disease Control and Prevention (CDC) estimates that over 26 million new cases of sexually transmitted diseases (STDs) occur each year.¹ STD infections can persist for an extended period, and most people are unaware they are infected until advanced symptoms appear.²

Screening is critical in effectively stemming the spread from person to person and is also the first step toward getting successful treatment.³ Bacterial STIs disproportionately affect HIV-infected men who have sex with men (MSM) compared with HIV-uninfected MSM. At the same time, screening for bacterial STIs in HIV care settings, particularly for gonorrhea and chlamydia at extragenital sites (i.e., the pharynx and the rectum), remains low.⁴

The UW PTC recognized a significant gap existed in extragenital STI testing, leading to underdiagnosis and continued transmission, particularly in high-risk groups like HIV-infected (MSM).⁵

They partnered with us to address this challenge and transform STI testing through a creative, accessible and scalable solution.

Visual communication that breaks down barriers and transforms testing practices

We worked with UW PTC over the course of a decade to develop effective and accessible self-testing guides, tackling communication challenges that ranged from extragenital screening to universal design. The guides we created with UW PTC leverage visual communication’s power to overcome testing barriers, such as lack of awareness, inconsistent practices and patient discomfort.

Our initial engagement started in 2014 with a focus on pharyngeal and rectal self-testing. This initial emphasis addressed two key issues: the disproportionate impact of bacterial STIs on HIV-infected MSM and the low rates of screening for gonorrhea and chlamydia at extragenital sites within HIV care settings.⁶ During this time, screening in the pharynx or rectum for gonorrhea and/or chlamydia hovered around 2.3% – 8.5%.⁴ UW’s Dr. Lindley Barbee presented early findings at the 2014 CDC STD Prevention Conference⁷, highlighting significant increases in screening coverage and patient acceptability with self-testing. Her presentation, titled “Effectiveness and Patient Acceptability of a Self-Testing Intervention for STI in an HIV Primary Care Setting,” showcased that the implementation of an STI self-testing program at a large HIV clinic led to significant increases in screening coverage, including a 29.1% increase in pharyngeal testing and a 30.0% increase in rectal testing.⁷ By creating self-testing guides that clearly conveyed instructions in a visually appealing, accessible way, we were able to help UW PTC in their aim to support better health in patient populations.

Over the next eight years, the project evolved in several key ways.

First, it expanded to include vaginal self-testing, acknowledging the importance of comprehensive STI screening for women.

Then, it added a Spanish series, in addition to including illustrations sensitive to diverse ethnic backgrounds, addressing a broader spectrum of STI testing needs and cultural considerations. This evolution also emphasized a universal design approach, ensuring accessibility for all individuals, in line with the National Network of STD Clinical Prevention Training Centers’ (NNPTC) call for welcoming and holistic clinical environments for vulnerable populations.⁸

The visual guides are now available in 22 languages (UW PTC), making them accessible to a diverse population regardless of linguistic background, further demonstrating the project’s commitment to inclusivity.

More color. More inclusion.

In 2022 the UW team reached out again to update the illustration series to allow for a more inclusive set by adjusting the skin tones and adding 20 additional language translations. We were up for the challenge and generated several options for the UW team to review. In the end, our teams settled on a blue, green and purple palette, one for each of the testing types.

A legacy of empowerment in public health

What makes Cognition’s work unique is the fusion of evidence-based research with creative design. We are proud to have partnered with the UW PTC to develop a resource that is effective but also accessible and empowering.

This project directly addresses the need to enhance the capacity and quality of STI services.⁸ Most patients (85%) found the Patient Assessment Form to be “extremely helpful,” and the majority reported that the instructional posters were “extremely helpful” (99% throat poster, 87% rectal poster).⁶

As noted by the NNPTC, STD care providers must enhance their capacity and quality of services, including extra-genital chlamydia and gonorrhea testing, to adequately respond to the challenges of rising STD rates.⁸ The client was most pleased with the ability of the guides to reach diverse audiences and the tangible impact they have had on increasing testing rates and improving patient experiences.

This project models how visual communication can be leveraged to address critical public health challenges and promote a more equitable approach to healthcare. The National Association of County and City Health Officials and The AIDS Education and Training Center Program promote these resources for healthcare providers. Columbia Health also uses these self-test visual guides.