College students need a more anonymous, accessible way to quickly check STD health status and help increase and raise awareness around STD testing 

When surveying 50 Dartmouth students, we learned that the current process of acquiring an STI test has both benefits and pain points. While students describe Dick’s House staff as friendly and testing as relatively available, they mentioned the time commitment, scheduling process, and lack of information about testing to be significant barriers. 

To combat this issue, we designed the BeSTIe: an STI test strip dispenser that can be placed in bathroom stalls around college campuses, democratizing access to testing and motivating college students to be more proactive about taking care of their sexual health. 

We envision our user to be college students across the globe, but for the purposes of launching the product, we focused our user research on Dartmouth College undergraduates. The user could even be expanded beyond college students, such as if the dispenser is placed in other common locations like public libraries or Planned Parenthood. 

We envision our purchaser to be primarily university administrators. At Dartmouth College, we spoke with Dartmouth Student Government (DSG), the Office of Residential Operations, the Office of Residential Life, the Student Wellness Center, and Dick’s House to gain an understanding of how such a device could be implemented. We learned that recently, DSG collaborated with Facilities, Operations, and Management (FO&M) to place tampon dispensers at no extra cost in various bathrooms around campus. Initially, DSG and FO&M both helped fund this initiative, and custodial staff that clean restrooms check daily to see if the dispensers need to be refilled. Using this program as a blueprint, we are confident that the BeSTIe could easily be implemented onto Dartmouth’s campus with ease, and we hope to work with administration and DSG to make this initiative a reality. 

Our team identified two areas of interest in the existing technology: the way tests are administered and the way tests are received by the user. 

Firstly, urine based tests for STIs can test for chlamydia, gonorrhea, HPV, and trichomoniasis, and can either be done by a lab or at-home rapid test (Boskey). Lab tests are expensive and more time and resource intensive, requiring either a trip to a clinic or mailing results back to a lab for analysis. Rapid tests for many different STIs are available and work similar to those for COVID-19. A key benefit of these tests is that a person can self diagnose, but they work solely for one specific STI. Therefore, the user must know what to test for and will likely only purchase these if they already have symptoms, and this shortcoming was supported in our early user insights.

Paper urinalysis strips that rely on a color change test for a variety of indicators such as pH, proteins, and glucose are the second, more readily available standard for rapid diagnostics. However, they are non-specific for STIs and test more universally for a biomarker of infection. A positive urine dip-test for leukocyte esterase (a product of white blood cells) has been shown to be a sign of chlamydia or gonococcal investigation. The sensitivity is not as high on rapid or dipstick tests as lab tests, meaning they are not as accurate, but if placed so they can be used frequently they can effectively monitor for infection and increase people’s interest in their health status. As a result, we have identified the most pressing concern surrounding these tests to be that people rarely take initiative to order them, and if they do, they tend to purchase a test once instead of frequent testing, leaving them vulnerable to undetected infections.

Therefore the area which we wanted to focus on in tackling our user’s need is the way tests are currently made available. In situ testing reduces the barrier to use almost completely and integrates it into daily routine. Research has noted that testing is much more simple if it is continuously used on indicators of an individual’s health that are “naturally excreted every day” (Park et al.). A key innovation in this field is the smart toilet. One instance of this is patent EP3373003B1 (Spangenberg et al.) seen in Figure 1 which captures the urine in a separate container into which a test is dipped. Another is patent US10383606B1 (McCord et al), seen in Figure 2 this is a modification to the toilet which deploys a urine collector above the water and allows for analysis via app integration. This invention is more promising as it does not  require a change to toilet plumbing, but both technologies require significant toilet modifications. Given their specificity to a single user, they also target an individual user rather than a diverse range of users. 

A system currently being developed by researchers at Stanford University is a “smart toilet”. This technology includes toilet bowls lined with pressure sensors, urinalysis strips, and stool cameras, and it can test for up to 10 biomarkers of a range of STDs and other diseases. The focus of this technology is a fully automated system that sends information directly to a healthcare team. While prioritizing data privacy, it does not allow the user to fully access their own information and requires they have a team of staff willing to monitor their results for them. This solution is simply unrealistic for the average college student. Some of this technology is currently on the market and costs up to $8000, which, for institutions like universities, is too expensive for bulk purchases. 

Below are the specifications we used to address our need. The four highlighted are the ones which we weighted the most highly based on user feedback and ethics. The first is functionality. Because we choose to distribute an existing test that already has a level of trust for users, we need to make sure that our solution preserves the accuracy of that test so students are getting the most truthful information based on their expectations. The solution must also be intuitive. We don’t want any barriers to use, because testing for illness might already be a complicated and potentially emotional situation for people. Third, the test must be anonymous, because we want to protect students’ health status and comfort in testing. In particular, we don’t want the move from private to public testing to discourage doing so in any way. Most importantly, the specification which is the key innovation of our solution is ensuring that students do not have to change their routine to test. We want to reduce the time taken out of students’ days to check up on their health to see if they need followup appointments, and therefore hopefully work towards a more efficient and healthy campus.

FoamCore Prototypes

We had many iterations of prototypes throughout the building process. Initially, we brainstormed with three key concepts in mind: how it works, what it looks like, and how it could be tested. We initially focused on a wheel mechanism that would dispense a roll with a test strip, that could then be cut off. We ran into issues with functionality and implementability when first considering various ways the test strips in our foamcore prototypes. At this stage, we struggled deciding whether the device would sit in the toilet or on the stall wall.  Our early prototyping was for the in-toilet solution which we found to be not functional or implementable because it destroyed the strips and would be difficult to work with existing toilets of all different sizes. Our next foamcore prototype was for the mechanism of dispensing which ultimately failed to produce consistent results and was destroying the test strip. We next looked at a pool test dispenser as a model, however the strips had too much exposure to the air and touch points which would not work with our urinalysis strips that need to be kept sanitary and stored with limited air exposure. We learned a lot from foam core creation as the issue gave a better sense of what worked and what did not. Ultimately, we valued the roller mechanism as it kept our device and the test strips implementable, functional, intuitive, and sanitary.

After finding there were no rollable test strips on the market, we ordered strips from a company that delivered individual strips in a small box. As a result, we pivoted to a box we constructed in SolidWorks that could be attached to a stall wall and have the strips stacked. This included a casing lid, weight to compress the strips, a wheel which turns to dispense, and a slot that closes between uses. This idea allowed for no change to the user’s routine and it was instant, inuitive, and affordable. The test strips do not test for one STI but are a biomarker to infection. The small casing and slots keeps the test strips clean, which keeps the tests accurate. The device hangs on the wall and is refillable, which makes it integrative with existing bathroom structures. The wheel and crank device allows a test strip to dispense and helps the ease of use. The entire device is contained within the stall which keeps the experience anonymous.

Upon concept testing, we received many helpful user insights that helped our prototype iterations. All sexually active users said that they would be interested in using the BeSTIe. Many had conflicting ideas on where they would like to see it: while some mentioned more trafficked restrooms like FFB might be ideal and help destigmatize STI testing, others preferred the privacy of a residential hall bathroom or single stalled bathroom. Many students commented on the quietness of our prototype, which added to their feeling of anonymity when using  it. Several students commented that they would use the product even if they did not have symptoms and encourage others to do so as well. We also received some criticisms. Notably, students expressed concerns about people flushing the tests, disgust with holding a urine covered test strip for several minutes, and hesitation when turning the crank because they were worried they might break it. These insights will help us continue iterating to improve our product.

We also received helpful insights from the potential purchasers we interviewed. The Student Wellness Center suggested that since our STI tests are less accurate than Dick’s House and are a biomarker for STIs, we might create anxiety in the ambiguity of our results. Purchasers were also concerned about our lack of emphasis on getting a doctor involved afterwards. These insights helped us create a very visually appealing poster that clearly communicates with users what the tests do, as well as providing some phone numbers to contact medical consultations. Aside from these concerns,  potential purchasers seemed excited about our idea, which was really wonderful to hear. 

There were also many mechanical bugs that occurred during prototype testing. We found that the product works well, but putting the strips inside and keeping them in place is challenging  at times. Furthermore, sometimes multiple strips come out together leading it to not entirely functioning correctly. Some important considerations to further adaptations include the angle of the strips for the ease of strip exit, the friction of the wheel to keep the strips intact, and using a better manufactured weight that will prevent the components from moving inside. One potential solution that could help our product work more smoothly is forming a partnership with test strip manufacturers to deliver the strips already stacked, so that we can then easily place them in our cartridge. We also may want to do additional calculations to understand the best angle our foamcore slanted piece should be at to optimize the experience of taking out a test strip. 

Based on our insights from product and concept testing and interviews with the Student Wellness Center, Administration, Dick’s House, and Student Government we determined the following goals for our product to be ethical and sustainable;

Our product must have credibility, our customers must have trust and confidence in the use of our product. The use of our product must also ensure the anonymity of the user. Our product must be safe in use.

Our product will be manufactured from recycled materials and will be purchased for multiple uses over an extended period of time.  

The low impact assembly process of our chosen materials as well as local manufacturing with minimal transportation costs and distance will reduce the overall carbon footprint of our product.

OKALA impact factor 

These calculations are based on the materials that will be used in the manufacturing process of the casing as well as mechanical       parts of our product.

The total OKALA impact factor for our product is 3.785

Below is a summary of the most important elements of our business model.

Our key partners will work with our customers to purchase our product and which will provide students with an easy and accessible way to check their health status. 

Cost Breakdown

The cost breakdown of our Business Model is calculates as follows;

Our variable costs are based on the cost of our materials as well as their shipping and assembly.
The cost of PP Plastic is $0.23 per pound, each dispenser weighs 2 lbs, plus 0.5 lbs of aluminium which is $0.50 per pound, making the cost of each dispenser $0.83.  The cost of a cartridge of 100 test strips is $12.
This makes our total variable costs $12.83 per unit.

Our fixed annual costs are based on factory rent and utilities, our marketing and outreach investments, and the wages of our staff. Our factory costs are $10,000. There will be a maximum budget of $5,000 for our marketing and outreach. We plan on part-time staffing 1 salesman and 1 executive who earn a salary of $20,000 and $25,000 respectively.
This makes our total  fixed costs $60,000 per year.

To break even we would have to sell our product at $13.83 per unit.

Elizabeth Boskey, PhD. (2021, September 15) Urine Testing for Sexually Transmitted Infections https://www.verywellhealth.com/urine-testing-for-   gonorrhea-and-chlamydia-3132777. 

McCord, Matthew et al. (2019, August 20) Toilet Based Urine Analysis System. US10383606B1.https://patents.google.com/patent/US10383606B1/en?oq=US10383606B1 

Park et al. (2020, June) A mountable toilet system for personalized health monitoring via the analysis of excreta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377213/

Spangenberg, Bernd et al. (2022, February 9) Urine test strip. EP3373003B1. https://patents.google.com/patent/EP3373003B1/en?oq=EP3373003B1