Sexual health services on the brink

White, Caroline

doi:10.1136/bmj.j5395

Cited by 17 publications

(17 citation statements)

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“…e-STI testing was initially positioned within a normative agenda to expand access to health services 4. In the wake of cuts to sexual health funding in England, e-STI testing is increasingly viewed as a means to meet existing demand for STI testing at reduced cost 26 27. In London, many genitourinary medicine clinics divert asymptomatic patients to online care, prioritising scarce resources for more complex cases.…”

Section: Discussionmentioning

confidence: 99%

Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial

et al. 2019

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ObjectivesTo assess the effectiveness of an internet-accessed STI (e-STI) testing and results service on testing uptake among young adults (16–30 years) who have never tested for STIs in London, England.MethodsWe conducted secondary analyses on data from a randomised controlled trial. In the trial, participants were randomly allocated to receive a text message with the web link of an e-STI testing and results service (intervention group) or a text message with the link of a website listing the locations, contact details and websites of seven local sexual health clinics (control group). We analysed a subsample of 528 trial participants who reported never testing for STIs at baseline. Outcomes were self-reported STI testing at 6 weeks, verified by patient record checks, and time from randomisation to completion of an STI test.ResultsUptake of STI testing among ‘never testers’ almost doubled. At 6 weeks, 45.3% of the intervention completed at least one test (chlamydia, gonorrhoea, syphilis and HIV), compared with 24.1% of the control (relative risk [RR] 1.88, 95% CI 1.47 to 2.40, p<0.001). For chlamydia and gonorrhoea testing combined, uptake was 44.3% in the intervention versus 24.1% in controls (RR 1.84, 95% CI 1.44 to 2.36, p<0.001). The intervention reduced time to any STI test (restricted mean survival time: 29.0 days vs 36.3 days, p<0.001) at a time horizon of 42 days.Conclusionse-STI testing increased uptake of STI testing and reduced time to test among a young population of ‘never testers’ recruited in community settings. Although encouraging, questions remain on how best to manage the additional demand generated by e-STI testing in a challenging funding environment. Larger studies are required to assess the effects later in the cascade of care, including STI diagnoses and cases treated.

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Section: Discussionmentioning

confidence: 99%

Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial

et al. 2019

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“…The researchers used multiple active methods to reach and engage their target group; therefore, to sustain the benefits of the e-STI testing intervention, these health promotion activities would need to continue. Even in times of economic austerity, e-STI testing should not be seen as a substitute for fully funded clinic-based services [ 13 ].…”

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confidence: 99%

Sexually transmitted infections—Research priorities for new challenges

Low

Broutet

2017

PLoS Med

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“…There was a lack of agreement between service users and providers on the role and scope of online and digital interventions and hesitation around the role of automated triage. As sexual health service cuts continue to restrict the scope of face to face services11 and incorporate digital pathways, resolving this contradiction is crucial to planning service implementation and ongoing monitoring. Using the MRC framework for complex interventions, the next step is to adapt the potentially acceptable targeted one-to-one and digital interventions and pilot this with routine care settings, to assess feasibility prior to conducting a large-scale trial.…”

Section: Discussionmentioning

confidence: 99%

“…There has been a growing recognition of the potential to harness ‘big data’ for more efficient and effective targeting of health promotion 10. This is particularly important in sexual health, in a period of considerable budget restrictions 11. Exploiting routine sexual health data12 could provide a mechanism to triage service users into tailored health promotion interventions.…”

Section: Introductionmentioning

confidence: 99%

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

Roy

King²,

Gilson

et al. 2019

Sex Transm Infect

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ObjectiveBehavioural interventions have been shown to reduce sexual behaviours associated with increased risk of sexually transmitted infections in young people (<25 years) and men who have sex with men (MSM) internationally, but evidence from England is limited. We aimed to explore service provider and user experiences and perspectives on behavioural interventions to reduce sexual behaviour risks, and the use of automated methods to triage individuals to these services.MethodsWe conducted a sequential mixed methods study with sexual health service providers and users in 2015/2016. Qualitative interviews with providers and service users (heterosexual young people and MSM) in London and Brighton allowed us to explore a range of experiences and expectations. A subsequent national web-survey of service providers measured the feasibility of delivery within existing resources and preferences for intervention attributes.ResultsWe conducted 35 service user (15 heterosexual young people; 20 MSM) and 26 provider interviews and had 100 web-survey responses. We found considerable heterogeneity in prevention services offered. Service users and providers were broadly supportive of tailoring interventions offered, but service users raised concerns about automated, data-driven triage, particularly around equity and fairness of service delivery. Digital technologies, including social media or apps, were appealing to providers, being less resource intensive. However, one-to-one talking interventions remained popular with both service users and providers, being familiar, trustworthy and personal. Key tensions between desirability of interventions and availability of resources to deliver them were acknowledged/recognised by providers and users.ConclusionOverall, behavioural interventions to reduce sexual behaviour risks were viewed favourably by service providers and users, with key considerations including: privacy, personalisation and convenience. However, introducing desirable targeted interventions within heterogeneous sexual health settings will require resources to adapt interventions and research to fully understand the barriers and facilitators to use within routine services.

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Sexual health services on the brink

Abstract: Public health funding is experiencing sustained cuts while demand keeps rising. The BMJ asked local authorities how sexual health services are being affected. Caroline White reports

Cited by 17 publications

References 0 publications

Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial

Does internet-accessed STI (e-STI) testing increase testing uptake for chlamydia and other STIs among a young population who have never tested? Secondary analyses of data from a randomised controlled trial

Sexually transmitted infections—Research priorities for new challenges

Healthcare provider and service user perspectives on STI risk reduction interventions for young people and MSM in the UK

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