Web-Based Activity Within a Sexual Health Economy: Observational Study

Abstract

BackgroundRegular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need.ObjectiveThe aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead.MethodsData on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other.ResultsIntroduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period—2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses.ConclusionsThis evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion.

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

“…We did not include fixed overheads such as building and administration in our cost estimations as these overhead costs do not fluctuate with service activity. 5 Nor did we include diagnostic and treatment costs as within the scenarios explored these will remain the same; diagnostic tests are undertaken within the same laboratory and patients diagnosed with an infection are assumed to attend for treatment. The cost of providing online self-sampling was based on actual practice undertaken at the Unity SHC.…”

“…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.…”

“…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][4][5] A recent randomised controlled trial indicates that onlinebased 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.…”

“…Many patients attending SHSs for STI and HIV testing have no symptoms 5 9 and could potentially self-sample without the need to attend a sexual health clinic (SHC). The Unity SHC delivers SHSs for Bristol, North Somerset and South Gloucestershire in the UK.…”

Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation

“…Digital health services require users to take on new responsibilities for self-care, such as self-taken finger prick blood samples or interpreting results of tests completed at home, and these new roles require additional support [ 3 , 4 ]. This support may be delivered through a wide range of media, including telephone, video conversations, and messaging.…”