STI testing and subsequent clinic attendance amongst test negative asymptomatic users of an internet STI testing service; one-year retrospective study

An evaluation of an online STI service across London: reviewing uptake, utility and outcomes over a 4-year period

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.

Use of GetCheckedOnline and testing through healthcare providers among repeat users of British Columbia's digital testing service for sexually transmitted and blood-borne infections: Findings from a cross-sectional survey

Background

Digital testing services for sexually transmitted and blood-borne infections (STBBI) are becoming more common in Canada. There is little evidence supporting the assumption that these services reduce healthcare system burden. To explore this further, we described patterns of provider-based testing among repeat users of a digital STBBI testing service, and their association with access barriers.

Methods

We conducted a cross-sectional survey in November 2022 of repeat GetCheckedOnline.com users (≥2 tests, with 1 test between April and October 2022). We stratified participants into three use patterns of GetCheckedOnline for testing, using ordinal logistic regression to examine associations with barriers reflecting availability, accessibility, acceptability and appropriateness of health services (applying weights to adjust for non-responders).

Results

Of 798 participants (17.2% of 4633 eligible), 52.6% only and 35.8% mostly tested through GetCheckedOnline; 14.5% tested more often/equally through healthcare providers. Availability was associated with greater use of GetCheckedOnline (e.g., not having a primary care provider, OR 2.03, 95% CI [1.52-2.73]), and appropriateness with lower use (getting tested part of clinical care, OR 0.07 95% CI [0.05-0.11]). Participants < 25 years, high school educated or less or born outside Canada reported greater use of GetCheckedOnline for testing while 2S/LGBTQ+ and full-time employed participants reported lower use. Most participants (88.0%) would have tested through a provider if GetCheckedOnline were not available.

Conclusion

GetCheckedOnline use was associated with barriers to the availability of provider-based testing. Digital STBBI testing services may improve access to testing and reduce demands on healthcare providers for testing.

Moving Toward Online-Based Sexually Transmitted Infection Testing and Treatment Services for Young People: Who Will Use It and What Do They Want?

BACKGROUND

The market for online sexually transmitted infection (STI) services is rapidly expanding. Online health services often have unequal uptake among different demographics of the population. There is a need to understand how different online delivery options for STI testing may appeal to different groups of young people, particularly young people who have higher rates of STI diagnoses.

METHODS

An online survey of young Australians aged 16 to 29 years was conducted to understand service preferences regarding consultation (telehealth, fully automated questionnaire), testing (electronic pathology form, at-home self-sampling), and treatment (e-prescriptions, mailed oral tablets). Multivariable multinomial logistic regression examined associations between user characteristics and service preferences, and adjusted relative risk ratios (aRRRs) and 95% confidence intervals (CIs) are presented.

RESULTS

Among 905 respondents, rural youth were more likely to prefer fully automated questionnaires (aRRR, 1.9; 95% CI, 1.0-3.5) over telehealth consultations, whereas culturally and linguistically diverse (CALD) youth were less likely (aRRR, 0.4; 95% CI, 0.2-0.7). Rural youth preferred at-home self-sampling kits (aRRR, 1.9; 95% CI, 1.3-2.7) over electronic forms for on-site collection at pathology centers, with the opposite for CALD youth (aRRR, 0.7; 95% CI, 0.5-1.0). Receiving oral antibiotics by mail was preferred by rural youth (aRRR, 2.3; 95% CI, 1.1-4.6) over for in-clinic treatment, but not for CALD youth (aRRR, 0.5; 95% CI, 0.4-0.8).

CONCLUSIONS

Our findings suggest that rural youth tend to prefer self-navigated and automated options, whereas CALD prefer options with greater provider engagement. Online STI service providers should consider how different service options may affect equitable uptake across the population and implications for addressing disparities in testing and treatment.