Scoping review of online postal sexually transmitted infection services: access, usage and clinical outcomes

Kirsi Sumray, Karen C. Lloyd*, Claudia Estcourt, Fiona Burns, Jo Gibbs

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: There has been considerable expansion in online postal self-sampling STI services in many parts of the UK, driven by increasing demand on sexual health services and developments in diagnostics and digital health provision. This shift in service delivery has occurred against a backdrop of reduced funding and service fragmentation and the impact is unknown. We explored characteristics of people accessing and using online postal self-sampling (OPSS) services for STIs in the UK, the acceptability of these services, and their impact on sexual health inequalities.
Methods: A scoping review was conducted of studies published in English-language based on pre-agreed inclusion/exclusion criteria, between 01/01/2010 to 07/07/2021. Nine databases were searched, and 23 studies that met the eligibility criteria were included. Studies were appraised using the Mixed Methods Appraisal Tool.
Results: Study designs were heterogenous, including quantitative, qualitative and mixed method analyses. The majority were either evaluating a single site/self-sampling provider, exploratory or observational and of variable quality. Few studies collected comprehensive user demographic data. Individuals accessing OPSS tended to be asymptomatic, of White ethnicity, women, over 20 years, and from less deprived areas. OPSS tended to increase overall STI testing demand and access, although return rates for blood samples was low, as was test positivity. There were varied results on whether services reduced time to treatment. OPSS services were acceptable to the majority of users. Qualitative studies showed the importance of trust, confidentiality, discretion, reliability,
convenience and improved patient choice.
Conclusion: OPSS services appear highly acceptable to users. However, uptake appears to be socially patterned and some groups that bear a disproportionate burden of poor sexual health in the UK are under-represented among users. Current provision of online self-sampling could widen health inequalities, particularly where other options for testing are limited. Work is needed to fully evaluate the impact and cost-effectiveness of OPSS services.
Original languageEnglish
JournalSexually Transmitted Infections
Publication statusAccepted/In press - 1 May 2022

Keywords

  • sexual health
  • digital health
  • service delivery
  • STI testing

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