Article Text

Download PDFPDF
An evaluation of an online STI service across London: reviewing uptake, utility and outcomes over a 4-year period
  1. Victoria Tittle1,
  2. Sara Louise Day2,3,
  3. Anna Tostevin4,
  4. Adrian M Kelly3,5,
  5. Jonathan Spate3,6,
  6. Fiona Burns7,
  7. Jo Gibbs8,
  8. Alison Howarth9,
  9. Ann Sullivan2
  1. 1Sexual Health and HIV, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
  2. 2Sexual Health and HIV, Chelsea and Westminster Healthcare NHS Trust, London, UK
  3. 3Sexual Health London, SHL, London, UK
  4. 4Centre for Sexual Health & HIV Research, University College London, London, UK
  5. 5Lead Commissioner Sexual Health e-Service, City of London Corporation, London, UK
  6. 6Preventx, Sheffield, UK
  7. 7Centre for Sexual Health & HIV Research, UCL, London, UK
  8. 8Infection and Population Health, University College London, London, UK
  9. 9UCL Institute for Global Health, University College London, London, UK
  1. Correspondence to Dr Victoria Tittle; victoria.tittle{at}nhs.net

Abstract

Objectives Since 2018, Sexual Health London (SHL) has provided remote sexually transmitted infection (STI) testing services to London residents over 16 years of age. SHL was an asymptomatic screening service. In 2020, SHL widened access to non-urgent symptomatic testing. We undertook a 4-year evaluation on the uptake of SHL’s online testing pathway and outcomes, including the association of positive chlamydia and gonorrhoea nucleic acid amplification test (NAAT) outcomes with user demographics and user utility.

Methods This is a retrospective data analysis of routine SHL clinical data from 8 January 2018 to 31 March 2022 of all STI test kit orders, focusing on HIV, chlamydia and gonorrhoea outcomes. Descriptive analysis on uptake of each stage of SHL’s clinical care pathway is provided, including HIV testing outcomes. Binary logistic regression was used to examine the association between SHL user-completed online consultation information, SHL uptake and chlamydia and gonorrhoea NAAT results (negative or positive).

Results During the evaluation period, there were 1 476 187 orders made by 670 293 unique users. The return rate for chlamydia and gonorrhoea NAATs was 79.5% and 67.6% for HIV blood samples. The positivity rate from sufficient samples was 4.5% for chlamydia, 1.6% for gonorrhoea and 0.3% reactivity for HIV. There were increased odds of a positive chlamydia and gonorrhoea NAAT result in non-cisgender women, those with a high number of STI orders, non-UK born and those who collected an STI test kit from a clinic-based service.

Conclusions To date, this is the largest number of orders in an evaluation of online postal sexual health infection testing in the UK, and highest return rate of samples, suggesting acceptability of SHL for STI testing. Positivity rates for chlamydia and gonorrhoea NAAT tests are lower than national figures, which may reflect asymptomatic screening prior to 2020 and testing of non-urgent symptoms since 2020.

  • delivery of health care
  • HIV
  • sexual health

Data availability statement

Data may be obtained from a third party and are not publicly available. Data were provided by Preventx with permission from SHL’s data controller.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data may be obtained from a third party and are not publicly available. Data were provided by Preventx with permission from SHL’s data controller.

View Full Text

Footnotes

  • Handling editor Nadja A Vielot

  • X @jogibbs76

  • Contributors VT designed, supported data acquisition, analysed and drafted the manuscript. JS and AT led on the data acquisition. SLD and AMK supported data acquisition. SLD, AT, AH, JG, FB and AS supported the design, analysis and drafting of the manuscript. AS conceived the evaluation. All authors supported revision of the manuscript. VT is the guarantor.

  • Funding VT received partial funding from City of London to support her work on this analysis.

  • Competing interests VT received supplementary funding from City of London to undertake the analysis. However, City of London had no role in the design of the evaluation. No other competing interests were declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.