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Observational Study
. 2018 Mar 7;20(3):e74.
doi: 10.2196/jmir.8101.

Web-Based Activity Within a Sexual Health Economy: Observational Study

Katy Me Turner  1 , Adam K Zienkiewicz  2 , Jonathan Syred  3   4 , Katharine J Looker  5 , Joia de Sa  6 , Michael Brady  7 , Caroline Free  8 , Gillian Holdsworth  6 , Paula Baraitser  7   9
Affiliations
Observational Study

Web-Based Activity Within a Sexual Health Economy: Observational Study

Katy Me Turner et al. J Med Internet Res. .

Abstract

Background: Regular testing for sexually transmitted infections (STIs) is important to maintain sexual health. Self-sampling kits ordered online and delivered in the post may increase access, convenience, and cost-effectiveness. Sexual health economies may target limited resources more effectively by signposting users toward Web-based or face-to-face services according to clinical need.

Objective: The aim of this paper was to investigate the impact of two interventions on testing activity across a whole sexual health economy: (1) the introduction of open access Web-based STI testing services and (2) a clinic policy of triage and signpost online where users without symptoms who attended clinics for STI testing were supported to access the Web-based service instead.

Methods: Data on attendances at all specialist public sexual health providers in an inner-London area were collated into a single database. Each record included information on user demographics, service type accessed, and clinical activity provided, including test results. Clinical activity was categorized as a simple STI test (could be done in a clinic or online), a complex visit (requiring face-to-face consultation), or other.

Results: Introduction of Web-based services increased total testing activity across the whole sexual health economy by 18.47% (from 36,373 to 43,091 in the same 6-month period-2014-2015 and 2015-2016), suggesting unmet need for testing in the area. Triage and signposting shifted activity out of the clinic onto the Web-based service, with simple STI testing in the clinic decreasing from 16.90% (920/5443) to 12.25% (511/4172) of total activity, P<.001, and complex activity in the clinic increasing from 69.15% (3764/5443) to 74.86% (3123/4172) of total activity, P<.001. This intervention created a new population of online users with different demographic and clinical profiles from those who use Web-based services spontaneously. Some triage and signposted users (29.62%, 375/1266) did not complete the Web-based testing process, suggesting the potential for missed diagnoses.

Conclusions: This evaluation shows that users can effectively be transitioned from face-to-face to Web-based services and that this introduces a new population to Web-based service use and changes the focus of clinic-based activity. Further development is underway to optimize the triage and signposting process to support test completion.

Keywords: internet; self-sampling; sexually transmitted diseases; testing.

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Conflict of interest statement

Conflicts of Interest: PB, MB, and GH are directors of SH:24, a community-interest company providing Web-based sexual health services.

Figures

Figure 1
Figure 1
Timeline of sexual health service changes in Southwark and Lambeth from 2014 to 2016.
Figure 2
Figure 2
Number of simple sexually transmitted infections (STI) tests delivered across the whole sexual health economy, by service provider, by quarter, from quarter 1 (Q1) 2014 to quarter 3 (Q3) 2016 in Lambeth and Southwark, London.
Figure 3
Figure 3
Number of simple sexually transmitted infections (STI) tests performed at Camberwell Sexual Health Centre and SH:24 by calendar year and quarter, quarter 1 (Q1) 2014 to quarter 3 (Q3) 2016.
See this image and copyright information in PMC

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