Transforming Access: A Tribal Health Analysis of HIV and STI Self-Testing Models and Opportunities in Indian Country PREPARED FOR: SOUTHERN PLAINS TRIBAL HEALTH BOARD
Developed by The Raven Collective
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EXECUTIVE SUMMARY Sexual health disparities in American Indian and Alaska Native (AI/AN) communities are shaped by generations of systemic inequity, underfunded care systems, and cultural stigma. As HIV, STI, and syphilis rates increase in many Tribal regions, innovative approaches are urgently needed. One emerging and effective solution is self-testing and at-home specimen collection. These tools allow individuals to screen for infections discreetly, on their own time, and outside of potentially stigmatizing clinical environments. This report—commissioned by the Southern Plains Tribal Health Board (SPTHB)—reviews current literature on self-testing and analyzes existing at-home testing programs across the United States. With a focus on feasibility and cultural appropriateness for Tribal communities, it identifies which tools are best suited for use in Indian Country and offers guidance for future expansion, adaptation, and implementation. Key findings include: •
Native Test, operated by SPTHB with IHS support, stands out as a model program— designed by and for Indigenous people, with high uptake, trust, and cultural alignment.
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Other programs like I Want The Kit (IWTK) and Together TakeMeHome show strong potential for Tribal scale-up if accompanied by community-based outreach and education.
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Programs like OraQuick (HIV) and First To Know® (syphilis) are feasible but would benefit from Indigenous framing and local partnerships.
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Commercial testing platforms often lack both affordability and cultural relevance, requiring significant adaptation to be usable in Tribal contexts.
The report concludes with actionable next steps that prioritize community voice, cultural safety, and Tribal health sovereignty.
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TABLE OF CONTENTS Executive Summary ..........................................................................................2 Introduction .....................................................................................................5 Methodology ...................................................................................................5 Review of Literature .........................................................................................6 Existing Home Testing Programs ......................................................................8 Together TakeMeHome ........................................................................................................... 9 I Want The Kit (IWTK) ............................................................................................................... 9 Let's Get Checked ..................................................................................................................... 9 Everlywell ............................................................................................................................... 10 STDCheck ................................................................................................................................ 10 OraQuick ................................................................................................................................. 10 Test.me ................................................................................................................................... 11 First To Know® by NOWDiagnostics ....................................................................................... 11 Native Test.............................................................................................................................. 11 myLAB Box .............................................................................................................................. 12 Most Likely to Work in Indian Country – Ranked by Fit......................................................... 12 Summary ................................................................................................................................ 14
Conclusion ..................................................................................................... 15 Summary Recommendations ................................................................................................. 15
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Bringing care closer to home is not just a strategy—it is a step toward restoring Indigenous health sovereignty. By listening to
our
people,
investing
in
culturally
grounded innovation, and strengthening Tribal self-determination in health, we affirm our sacred responsibility to protect and promote wellness for generations to come.
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INTRODUCTION Sexual health remains a foundational component of well-being in Tribal communities, where access to timely, culturally grounded, and private testing options is critical for prevention, early detection, and treatment of HIV, STIs, and hepatitis. However, structural inequities—ranging from geographic remoteness to systemic underfunding—continue to limit access to care. In response, self-testing and home-based specimen collection options have emerged as powerful tools to increase testing coverage, reduce stigma, and empower individuals to take charge of their health. American Indian and Alaska Native (AI/AN) people face some of the highest rates of sexually transmitted infections (STIs) in the United States. In 2023, AI/AN communities experienced the highest rate of congenital syphilis and the second-highest rate of new HIV diagnoses among all racial and ethnic groups. These inequities are not due to individual behavior, but stem from longstanding structural factors—such as underfunded care systems, geographic isolation, systemic racism, and stigma—that continue to undermine access to timely and culturally appropriate testing, treatment, and education. This report provides a comprehensive review of the current evidence on self-collection and home testing strategies for HIV, STIs, and hepatitis, with a specific lens on feasibility and cultural appropriateness in Indian Country. Drawing from peer-reviewed literature and analysis of leading national testing programs, it explores both the promise and limitations of self-testing approaches for AI/AN communities. Particular attention is given to the potential for expansion of the Native Test program, currently operated through SPTHB in partnership with the Indian Health Service, and the viability of integrating or adapting other existing programs to better serve Tribal populations. As the burden of syphilis—including congenital syphilis—continues to rise across many regions, including within AI/AN communities, scalable and culturally responsive solutions are urgently needed. Home testing can play a critical role in meeting this need, especially when paired with community-based outreach, culturally informed materials, and strong linkage-to-care strategies. The findings and recommendations in this report are intended to inform future planning, funding, and implementation decisions to strengthen self-testing access across Tribal health systems.
METHODOLOGY This analysis draws from peer-reviewed publications, public health data, and programmatic reviews of major home testing models currently operating in the United States. Each program was evaluated based on feasibility in Tribal settings and cultural appropriateness for AI/AN
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communities. Criteria were informed by The Raven Collective’s experience in Indigenous public health systems and community-based care.
REVIEW OF LITERATURE The growing body of research on HIV and STI self-testing reflects increasing interest in accessible, community-centered strategies to promote sexual health. Between 2018 and 2025, dozens of studies have explored the effectiveness, acceptability, and public health impact of self-collected and home-based testing options. This section provides a curated summary of key literature relevant to Tribal communities, highlighting themes such as feasibility, user preference, digital innovation, and the structural conditions that shape access. Together, these findings offer valuable insight into the opportunities—and limitations—of integrating selftesting into Indian Country health systems. Self-Collected STI Testing Among Adolescents and Young Adults: A Qualitative Study (2025): This study explored adolescent and young adult perspectives on using self-collected STI test kits. Participants expressed a preference for the privacy, autonomy, and convenience of homebased urine and vaginal swab collection over clinic visits. LINK HIV Self-Testing Gaps Among New York City Clinic Clients (2025): In a survey of HIV testing clients in NYC, 78% said they would have preferred at-home self-testing if it had been available. The finding suggests persistent structural barriers and demand for expanding access to home kits, especially among Latinx and low-income populations. LINK A Perspective on Home-Based Sexual Health Care: Evidence, Access, and Future Directions(2025): This paper argues that integrating STI and HIV home testing into broader public health systems is critical to achieving equity. Authors advocate for removing regulatory, reimbursement, and technological barriers to expand access for underserved communities. LINK Evidence on Digital HIV Self-Testing From Accuracy to Impact: Updated Systematic Review (2025): This systematic review evaluates the accuracy of digital HIV self-testing and updates research on its acceptability, preference, feasibility, and impact, providing insights into the role of digital innovations in self-testing. LINK Exploring Facilitators and Barriers to STD/STI/HIV Self-Testing Among US College Students: A Scoping Review (2024): This scoping review explores factors that promote or hinder STD/STI/HIV self-testing among U.S. college students, providing insights into the acceptability and feasibility of self-testing in this population. LINK
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The effects of HIV self-testing on HIV incidence and awareness of status among men who have sex with men in the United States: Insights from a novel compartmental model (2024): This study uses a novel compartmental model to evaluate the effects of selftesting among gay, bisexual, and other men who have sex with men (MSM) in the United States, suggesting that self-testing can provide significant long-term reductions in HIV incidence and improve awareness of HIV status. LINK Promoting STI self‐testing through HIV self‐testing (2023): This paper discusses how the implementation of HIV self-testing (HIVST) can be leveraged to promote self-testing for other STIs, highlighting the potential to increase testing uptake and coverage. LINK How accurate is self-testing (home testing) for HIV? (2023): This article discusses the accuracy of HIV self-testing, where individuals collect their own specimens (oral fluid or blood) and perform the test themselves, including reading and interpreting the results. LINK Advances in HIV Self-Testing: Systematic Review of Current Status and Future Perspectives (2023): This systematic review compiles evidence about HIV self-testing technologies, strategies, and uptake in high HIV burden countries in Africa, providing insights into current developments and policy implications. LINK The evolution of HIV self-testing and the introduction of digital interventions to improve HIV self-testing (2023): This paper explores how digital interventions have been developed for HIV self-testing to improve the testing and linkage-to-care experience for users, enhancing accessibility and user engagement. LINK At-Home Specimen Self-Collection and Self-Testing for Sexually Transmitted Infection Screening Demand Accelerated by the COVID-19 Pandemic: a Review of Laboratory Implementation Issues (2022): This review focuses on at-home self-collection and self-testing for STIs, discussing benefits, challenges, and the potential to increase testing accessibility and uptake. LINK Increasing Access to HIV Testing Through Direct-to-Consumer HIV Self-Test Distribution — United States, March 31, 2020–March 30, 2021 (2021): This report describes a partnership to provide free HIV self-test kits to men who have sex with men, highlighting the potential of selftesting to engage individuals who have never tested and increase HIV testing frequency among this population. LINK A Pilot of Mail-Out HIV and Sexually Transmitted Infection Testing in Alberta, Canada: Discrete, Convenient, and Accurate (2021): This pilot study assesses the feasibility and accuracy of mail-out HIV and STI testing, finding that no individuals reported a positive HIV selftest that was confirmed, and 98.5% of respondents said they would recommend the HIV selftest kit. LINK
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Examining the effects of HIV self-testing compared to standard HIV testing services: a systematic review and meta-analysis (2021): This systematic review compares the effects of HIV self-testing (HIVST) to standard HIV testing services, finding that HIVST doubled the uptake of HIV testing in the general population compared to standard services. LINK Lessons Learned from Expansion of a Centralized Home HIV and STI Testing Program to Reach More Risk Groups and Provide More Tests (2021): This study reflects on the expansion of a centralized home testing program, discussing the scientific integrity of home tests and selfcollected samples, and their comparability to traditional point-of-care tests. LINK A Global Review of HIV Self-testing: Themes and Implications (2018): This comprehensive literature review examines the acceptability, feasibility, and effectiveness of HIV self-testing across various populations worldwide, identifying key themes and implications for public health. LINK Recent studies consistently demonstrate strong support for HIV and STI self-testing across diverse populations, citing its privacy, autonomy, and convenience—especially among adolescents, young adults, college students, and men who have sex with men (MSM). Mail-out and at-home kits are widely preferred over clinic-based testing and show high feasibility and acceptability. Evidence indicates that self-testing increases uptake, including among those who have never previously tested, and can reduce HIV incidence by promoting earlier diagnosis and care engagement. Digital innovations and centralized distribution models have further improved user experience, while systematic reviews confirm the accuracy and reliability of selftests. However, barriers persist—particularly for underserved communities—due to regulatory, reimbursement, and access challenges. Several studies recommend integrating self-testing into broader public health frameworks to advance equity and improve health outcomes.
EXISTING HOME TESTING PROGRAMS A wide range of HIV and STI self-testing programs are currently available across the United States, each offering different levels of accessibility, cost, cultural relevance, and clinical support. This section provides an overview of major home testing models, with a focus on their feasibility and appropriateness for use in Tribal communities. Each program is assessed using two key criteria: (1) how easily it can be accessed and used in rural or under-resourced AI/AN settings, and (2) how well it aligns with Indigenous values, privacy needs, and community trust. This analysis aims to support Tribal health leaders and partners in identifying which models may be most effective for scale-up, adaptation, or partnership in Indian Country.
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TOGETHER TAKEMEHOME Website: https://together.takemehome.org/ Testing Offered: Provides free HIV self-test kits by mail to residents of all 50 states and Puerto Rico who enroll through the program's website. The HIV self-tests are FDA-approved OraQuick devices that use mouth swabs and provide results in 20 minutes. Tests: Free FDA-approved OraQuick oral-swab HIV kits (20-min results) available nationwide. Feasibility: High – free, mail-based testing supports access in rural or transportation-limited Tribal communities. Cultural Appropriateness: Moderate – while privacy helps reduce stigma, materials are not tailored to Native audiences; could be improved with tribal outreach or messaging partnerships. I WANT THE KIT (IWTK) Website: https://iwantthekit.org/ Testing Offered: Offers free, accurate, and confidential in-home specimen collection and labbased testing for chlamydia, gonorrhea, HIV, syphilis, and hepatitis B & C. Availability varies by state. **Not currently funded but could refund. Tests: Free self-collected + lab-processed kits for chlamydia, gonorrhea, HIV, syphilis, hepatitis B/C (region-specific). Feasibility: High – already expanded through Indigi-IWTK partnerships to serve Tribal communities. Cultural Appropriateness: High – includes intentional collaborations with Native-serving organizations and has growing trust among AI/AN users. LET'S GET CHECKED Website: https://www.letsgetchecked.com/ Testing Offered: Provides a range of at-home STD testing options, including simple tests for chlamydia and gonorrhea, as well as comprehensive panels screening for multiple STIs. Cost:
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Simple 2 Test Kit: Screens for chlamydia and gonorrhea. $99 Standard 5 Test Kit: Screens for chlamydia, gonorrhea, trichomoniasis, HIV, and syphilis. $149 Complete 8 Test Kit: Screens for chlamydia, gonorrhea, trichomoniasis, HIV, syphilis
Feasibility: Moderate – convenient but cost may be prohibitive without subsidies or coverage. Cultural Appropriateness: Low – no Indigenous-specific tailoring; potential if integrated with Tribal health education or incentive programs. EVERLYWELL Website: https://www.everlywell.com/products/std-test-male/ Testing Offered: Offers discreet and fast at-home STD testing for chlamydia, gonorrhea, herpes, HIV, syphilis, and more. Provides accurate lab results without the need for a clinic visit. Feasibility: Moderate – accessible for internet-connected households; costs vary. Cultural Appropriateness: Low – not culturally grounded or tribally affiliated; stigma concerns remain unless paired with local education. STDCHECK Website: https://www.stdcheck.com/ Testing Offered: Provides quick results from the privacy of your home. Offers discreet and fast online STD testing, including FDA-approved HIV RNA Early Detection Test. Feasibility: Moderate – may be used in Tribal communities if logistics (printing, mailing, online access) are supported. Cultural Appropriateness: Low – lacks Native-centered framing or visual identity; may feel unfamiliar or distrustful without outreach. ORAQUICK Website: https://oraquick.com/ Testing Offered: Manufactured by OraSure Technologies, OraQuick is an at-home HIV test that uses an oral swab to detect HIV antibodies, providing results in as little as 20 minutes. Available for over-the-counter purchase.
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Feasibility: High – available in pharmacies and online; self-contained and quick. Cultural Appropriateness: Moderate – privacy supports uptake; could be enhanced with tribally developed instructional materials or public health campaigns. TEST.ME Website: https://test.me/ Testing Offered: Offers easy-to-use STI home testing kits, including comprehensive and standard test kits that screen for infections such as chlamydia, gonorrhea, HIV, and syphilis. Feasibility: Moderate – convenient and user-friendly; cost and internet access may be barriers. Cultural Appropriateness: Low – general population focus with no Indigenous-specific outreach or branding. FIRST TO KNOW® BY NOWDIAGNOSTICS Website: https://www.firsttoknow.com/ Testing Offered: Provides the first over-the-counter syphilis test, offering results in 15 minutes after a simple finger prick. Cost: Approximate cost is $27.97 Feasibility: High – especially relevant for areas with high syphilis rates and limited clinical access. Cultural Appropriateness: Moderate – accessible and simple to use; stronger relevance if paired with culturally tailored materials. NATIVE TEST Website: https://spthb.org/program/native-test/ or Text “NATIVE TEST” to 55251 Testing Offered: Free HIV and STI self-test kits mailed at-home, targeting Indigenous populations through Southern Plains Tribal Health Board via Indian Health Service funding. Feasibility: High – designed specifically for Tribal communities with built-in navigation and support. Cultural Appropriateness: High – created by and for Indigenous people; reflects values of privacy, trust, and access. Strong model for expansion. 11
MYLAB BOX Website: https://www.mylabbox.com/ Testing Offered & Cost: Offers 50+ at-home lab-tested kits, including: o
Single Tests: HIV — $49; chlamydia + gonorrhea — $79; syphilis — $89; herpes simplex II — $89
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Multi-Panel Kits: Safe Box (5 tests) — $169; Uber Box (8-panel) — $199; Total Box (14 pathogens, incl. HIV, Hep B/C, HSV-II, MG, HPV optional) — $369–399
Service Features: CLIA/CAP labs, results in 2–5 days, free physician consultation and telehealth if positive, discreet packaging Feasibility: Moderate – available nationwide with telehealth support; costs may be a barrier. Cultural Appropriateness: Low to moderate – not culturally tailored but offers discreet packaging and could be paired with Tribal health initiatives.
MOST LIKELY TO WORK IN INDIAN COUNTRY – RANKED BY FIT TIER 1: HIGH FEASIBILITY + HIGH CULTURAL APPROPRIATENESS Best-suited for implementation or scale-up in Tribal communities 1. Native Test ✔ Free, culturally rooted, designed by Indigenous partners ✔ Strong IHS/Tribal collaboration, stigma-aware, discreet � Ideal national expansion model Best Fit 2. I Want The Kit (IWTK) ✔ Free, regionally expanding, partnered with Indigi-IWTK ✔ Proven trust-building in Native communities � Supports multiple STIs with lab testing Highly Recommended for broader adoption 12
3. Together TakeMeHome ✔ Free, nationwide, discreet HIV-only oral swab ✔ High feasibility, already in use across some AI/AN settings � Could be made culturally tailored with Tribal messaging support Recommended (with supplemental Tribal outreach) TIER 2: HIGH FEASIBILITY, NEEDS CULTURAL ADAPTATION Effective with investment in culturally appropriate outreach or Tribal integration 4. OraQuick (OTC HIV Test) ✔ Quick, OTC access, strong privacy benefits ✔ Low stigma, simple use ✖ Not culturally specific — needs Tribal-based education or distribution Recommended with local adaptation (e.g., Tribal clinics, CHRs) 5. First To Know® (OTC Syphilis Test) ✔ Affordable, easy to use � Could help address urgent congenital syphilis concerns ✖ Not Indigenous-framed — needs community-informed roll out Recommended in high-syphilis burden Tribal areas TIER 3: MODERATE FEASIBILITY, REQUIRES SUBSIDY + OUTREACH Useful in some settings if cost is addressed and culturally appropriate support is added 6. myLAB Box ✔ Comprehensive panels, telehealth included ✖ High cost ($49–$399); no Indigenous tailoring � Could be effective with tribal funding, vouchers, or grants 13
Possibly useful for Tribal urban clinics or pilot programs 7. Let's Get Checked ✔ Mail-based convenience ✖ High Cost ($99–$249) and no Indigenous tailoring � Could work if integrated into Tribal health with coverage/subsidy Useful with financial + cultural adaptation 8. Everlywell ✔ Easy access, some retail availability ✖ Lacks Indigenous focus and affordability for low-resource users May work for higher-resourced users TIER 4: LOW FIT WITHOUT MAJOR ADAPTATION Least likely to succeed without targeted investment or redesign 9. STDCheck ✖ Website/lab-based model less intuitive for rural/reservation settings ✖ No cultural or visual relevance Unlikely to work without major investment in adaptation + promotion 10. Test.me ✖ Generic design, requires internet + literacy ✖ No targeted outreach to Tribal or rural users Low relevance unless bundled with other services SUMMARY BEST IMMEDIATE OPTIONS: Native Test, IWTK, Together TakeMeHome STRONG POTENTIAL: OraQuick + First To Know with Tribal customization
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SCALABLE WITH SUPPORT: myLAB Box and Let’s Get Checked (if funded + adapted) CAUTIONARY USE: STDCheck and Test.me without significant Tribal engagement
CONCLUSION Self-testing and home-based specimen collection offer a promising path forward to reduce barriers to sexual health care in Indian Country. From national mail-out programs to Tribal-led initiatives like Native Test, the evidence is clear: when designed with privacy, autonomy, and accessibility in mind, self-testing can increase early detection, reduce stigma, and save lives. However, effectiveness is not determined by technology alone—it is shaped by trust, cultural resonance, and community ownership. Programs that succeed in AI/AN communities are those that center Indigenous values, involve Tribal leadership in design and delivery, and provide clear, supported pathways from testing to care. As demonstrated in this review, programs with intentional Tribal partnerships—like I Want The Kit and Native Test—outperform generic commercial platforms on cultural appropriateness, engagement, and trust. To move forward, investments must go beyond test kits. They must include Indigenous-led education, storytelling, and public health messaging that affirms Native identity and promotes sexual wellness without shame. Tribal and urban Indian health programs must be supported to choose, adapt, and implement the approaches that work best for their people.
SUMMARY RECOMMENDATIONS TOP PRIORITIES FOR SPTHB AND PARTNERS: 1. Expand Native Test • Secure continued IHS and partner funding for broader geographic reach. • Strengthen navigation, follow-up care, and data collection. 2. Support Cultural Customization • Adapt top-tier external programs (e.g., OraQuick, First To Know) with Nativecentered messaging, packaging, and outreach. • Partner with CHRs and community educators for rollout. 3. Listen to Community Voice • Conduct community engagement with AI/AN individuals and Tribal partners to identify preferences, barriers, and needed supports. • Use community input to co-design testing strategies and educational materials. 4. Invest in Communication & Education
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Develop Indigenous-led public health campaigns focused on sexual wellness, privacy, and self-determination. • Normalize home testing through social media, storytelling, and trusted messengers. 5. Integrate and Sustain • Embed self-testing options into Tribal health services, community events, and harm reduction programs. • Seek policy, reimbursement, and infrastructure support for long-term sustainability. •
Ultimately, reclaiming sexual health and wellness in our communities requires not only tools, but trust—earned through culturally rooted, community-driven approaches. This is more than a public health strategy; it is an act of sovereignty.
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