Comparing the characteristics of users of an online service for STI self-sampling with clinic service users: a cross-sectional analysis

Abstract

ObjectivesOnline services for self-sampling at home could improve access to STI testing; however, little is known about those using this new modality of care. This study describes the characteristics of users of online services and compares them with users of clinic services.MethodsWe conducted a cross-sectional analysis of routinely collected data on STI testing activity from online and clinic sexual health services in Lambeth and Southwark between 1January 2016 and 31March 2016. Activity was included for chlamydia, gonorrhoea, HIV and syphilis testing for residents of the boroughs aged 16 years and older. Logistic regression models were used to explore potential associations between type of service use with age group, gender, ethnic group, sexual orientation, positivity and Index of Multiple Deprivation (IMD) quintiles. We used the same methods to explore potential associations between return of complete samples for testing with age group, gender, ethnic group, sexual orientation and IMD quintiles among online users.Results6456 STI tests were carried out by residents in the boroughs. Of these, 3582 (55.5%) were performed using clinic services and 2874 (44.5%) using the online service. In multivariate analysis, online users were more likely than clinic users to be aged between 20 and 30 years, female, white British, homosexual or bisexual, test negative for chlamydia or gonorrhoea and live in less deprived areas. Of the individuals that ordered a kit from the online service, 72.5% returned sufficient samples. In multivariate analysis, returners were more likely than non-returners to be aged >20 years and white British.ConclusionNearly half (44.5%) of all basic STI testing was done online, although the characteristics of users of clinic and online services differed and positivity rates for those using the online service for testing were lower. Clinics remain an important point of access for some groups.

Factors associated with time to presentation for individuals with symptomatic uncomplicated genital gonorrhoea: a cross sectional cohort study of GToG trial participants

“…The reason for the delay in women is likely to relate to difficulty in identifying changes in the amount and nature of vaginal discharge, but the perceived stigma associated with attending a sexual health clinic may also be a contributory factor 9. Postal based testing for STIs using home self-sampling kits increases patient anonymity and reduces the perceived stigma of testing,23 and has the potential to reduce the time to presentation 24. However it remains unclear whether those who delay seeking care at a clinic would be more likely to use a self-sample kit at home, and if self-sampling at home translates to a reduced time to treatment 25…”

Modelling patient flows and resource use within a sexual health clinic through discrete event simulation to inform service redesign

“…2 One option for improving access and potentially reducing costs is through the provision of online-based STI and HIV self-sampling for asymptomatic patients. [3][4][5][6] Service users can order a test kit online, collect their own samples, return the samples and receive their test results. Patients who test positive for an STI or HIV would then be offered a clinic appointment.…”

“…Online services for STI and HIV self-sampling at home may address barriers to clinic use such as inconvenient opening hours, long waiting times, perceived stigma and travel cost. 3 7 8 Furthermore, online services are less expensive than a traditional clinic attendance, but patients do have concerns about privacy and ability to take the test accurately. 3–5 A recent randomised controlled trial indicates that online-based self-sampling increased the uptake of STI testing for all groups, including high-risk groups.…”

“… 3 7 8 Furthermore, online services are less expensive than a traditional clinic attendance, but patients do have concerns about privacy and ability to take the test accurately. 3–5 A recent randomised controlled trial indicates that online-based self-sampling increased the uptake of STI testing for all groups, including high-risk groups. 6 However, such a service would generate new demand, increasing the number of tests and total cost of testing, but it would reduce the cost per test 4 and would help address the PHE recommendation of ensuring access for the general population to SHSs.…”

“Putting people in charge of their own health and care?” Using meta‐narrative review and the example of online sexual health services to re‐think relationships between e‐health and agency

“…In this paper, we problematize these assumptions about e‐health and agency by deploying a meta‐narrative review approach in conjunction with consideration of the example of online sexual health services, thereby providing a richer policy‐relevant account of the possible relationships between e‐health and the agency of both users and providers of services. Our prompt to investigate these questions was the experience of a four‐year evaluation of e‐sexual health services, where agency emerged as an important construct in conversations from initial funding applications and through service development and delivery . Online sexual health services offer sexual health information, testing and treatment for sexually transmitted infections (STIs) with tests sent home, samples collected by the service user and posted to the laboratory and results sent by text message .…”