We at Ash Wellness were honored to attend STD Engage 2023 in New Orleans with public health officials and STD directors from across the country. We were grateful to hear them speak about their ongoing challenges, partnerships, and successful programs. Like many in our field, we were alarmed by numbers from the recent CDC STD Surveillance report and are passionate about continuing to create technology that screens patients for STIs and links them to care. 

We presented a poster about our learnings as a diagnostics company that centers queer and transgender patients: 3 Ways to Radically Queer (Remote) STI Testing. We spoke with many brilliant people about our platform, but mostly, we saw this as an opportunity to listen to folks on the front lines. Here is some of what we learned as a vendor in the public health space, and how we hope to offer support in the future.  

Vendors need to listen to public health officials 

We understand the suspicion some public health officials hold around healthtech companies that promise the moon in exchange for their limited resources. Digital health, where many healthtech companies cut our teeth, rewards confident sales tactics that don’t always translate well to the public sector. 

Even vendors with good intentions can make the mistake of selling rather than listening, and public health officials with boots on the ground are right to question whether all vendors understand their needs. As we continue to support our public health partners, we aim to follow the lead of officials who understand their systems and patients best. 

At-home testing should acknowledge its limitations 

Ash Wellness was one of several at-home testing companies at STD Engage, a result of the post-pandemic diagnostics boom. Some diagnostics companies pitch a cure-all to public health woes without acknowledging the limitations of our platforms, which officials in the STI space are all too aware of.

Remote STI testing requires adherence to testing algorithm best practices, some of which may require specialized linkage to care services depending on the infection. We work with health departments to craft screening programs that meet patient needs and develop intervention plans where at-home testing capabilities may have limitations such as starting with screener tests for syphilis and hepatitis B and C, which are less expensive for them to onboard, even though any positive result will require confirmatory testing and follow up outreach from DIS workers. We work with our partners to develop UX/UI systems that connect patients to physicians or link them to follow up testing services.

In some cases, at-home testing necessarily translates to in-person care. Patients who test positive for syphilis or gonorrhea need antibiotics administered by a professional, though in some instances the testing and treatment can be completed entirely from home. We promote at-home testing because we see evidence that it makes healthcare more accessible, but what we really want is to support public health efforts to link patients to the care they need.

Public health is concerned about the long-term sustainability of at-home testing programs 

No public health initiative can bill insurance for at-home testing because the CPT codes do not exist. Some diagnostics vendors may try to pitch a system as insurance compliant, but until an insurance code is approved by the American Medical Association, billing is a non-starter. Public health departments can fund free STI at-home testing programs that reach vulnerable and at-risk patients with funds from the CDC, but they may struggle to maintain it. 

We strongly encourage public health departments to partner with federally qualified health centers with access to resources like Ryan White or 340b funding to sustain testing programs for the long haul. Clinics already work with patients that trust their care, so public health departments can support at-risk populations and also reduce spend on marketing efforts such as local billboards and advertisements. 

Conclusion:

We hear the concerns of public health officials. Diagnostics vendors can make enormous and sometimes misguided claims about the future of at-home health. We built Ash Wellness to support patients at the margins and to make healthcare more accessible and inclusive for all, but we were not the first at the table. We are enthusiastic to learn more from the public health heroes who do this work. We encourage public health departments to reach out to us about creating a successful diagnostics program. Let’s make something together. 

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