Assessment of online self-testing and self-sampling service providers for sexually transmitted infections against national standards in the UK in 2020

Abstract

ObjectivesOnline testing for STIs may help overcome barriers of traditional face-to-face testing, such as stigma and inconvenience. However, regulation of these online tests is lacking, and the quality of services is variable, with potential short-term and long-term personal, clinical and public health implications. This study aimed to evaluate online self-testing and self-sampling service providers in the UK against national standards.MethodsProviders of online STI tests (self-sampling and self-testing) in the UK were identified by an internet search of Google and Amazon (June 2020). Website information on tests and associated services was collected and further information was requested from providers via an online survey, sent twice (July 2020, April 2021). The information obtained was compared with British Association for Sexual Health and HIV and Faculty of Sexual and Reproductive Healthcare guidelines and standards for diagnostics and STI management.Results31 providers were identified: 13 self-test, 18 self-sample and 2 laboratories that serviced multiple providers. Seven responded to the online survey. Many conflicts with national guidelines were identified, including: lack of health promotion information, lack of sexual history taking, use of tests licensed for professional-use only marketed for self-testing, inappropriate infections tested for, incorrect specimen type used and lack of advice for postdiagnosis management.ConclusionsVery few online providers met the national STI management standards assessed, and there is concern that this will also be the case for service provision aspects that were not covered by this study. For-profit providers were the least compliant, with concerning implications for patient care and public health. Regulatory change is urgently needed to ensure that all online providers are compliant with national guidelines to ensure high-quality patient care, and providers are held to account if non-compliant.

Bacterial Special Interest Group Outputs: Provision of digital educational resources for Microscopy of STIs and Position Statement on inappropriate testing and treatment

“…Also within the last couple of years, the BSIG developed and released a position statement highlighting irregularities in STI service provision by some non-NHS online providers 3. Previous research, as well as plenty of anecdotal evidence from practising sexual health clinicians, has shown inconsistencies with national guidance such as the use of multiplex assays to test for organisms of dubious importance, testing for organisms where not indicated and using specimen types for which assays have not been properly validated 4. Furthermore, there are a large number of online pharmacies offering antibiotic treatment to people without needing proof that they have an STI and not offering first-line treatment in accordance with BASHH guidance 5…”

Web-Based STI/HIV Testing Services Available for Access in Australia: Systematic Search and Analysis

“…The Faculty of Sexual and Reproductive Healthcare and the British Association for Sexual Health and HIV in the United Kingdom [ 13 ] have produced standards for the web-based provision of sexual and reproductive health services to be used by providers of web-based services and to enable users to understand what to expect from the web-based provider. Our quality checklist captured the UK standards but was more comprehensive in line with similar reviews overseas [ 5 , 14 ]. The UK standards place considerable emphasis on patient safety including identifying and managing vulnerable populations (eg, children), requiring them to have a telehealth consultation.…”

“…We developed a quality checklist for the information and services provided by each website using testing recommendations from the Australian STI Management Guidelines [ 15 ], whether the tests offered were approved by the TGA [ 16 ], quality indicators from current reviews of web-based STI/HIV testing services available overseas [ 5 , 14 ], and quality service recommendations from the UK standards [ 13 ]. The domains in the checklist included pretesting, usability, testing, and follow-up.…”

“…Timely access to testing and treatment is crucial to reduce STI/HIV transmission but can be hindered by factors like service availability stigma and lack of knowledge [ 3 ]. In response to growing demand and the impact of the COVID-19 pandemic restricting access to in-person services [ 4 ], web-based STI/HIV testing services have proliferated in recent years particularly in the United Kingdom [ 5 ] and Canada [ 6 ]. Web-based services can include internet-only services that have no direct communication with users, telehealth services, or a combination of both.…”

“…Given the growing availability of web-based STI/HIV testing services and the lack of Australian guidance for such services, this study aimed to identify and assess the quality of available services in Australia. We developed a quality assessment checklist informed by the UK standards [ 13 ], reviews of web-based STI/HIV services available overseas [ 5 , 14 ], and adherence to the Australian STI Management Guidelines [ 15 ] and the Therapeutic Goods Administration (TGA) [ 16 ]. We also assessed services for their transparency in reliability and credibility using the Health on the Net Foundation code of conduct (HONcode) [ 17 ].…”