Remote self-testing for sexually transmitted infections, within online care pathways: how could this intervention deliver public health benefit? Formative research using chlamydia as an exemplar

Sexually transmitted infections (STIs) remain a public health challenge in England, despite free, confidential testing/treatment services. The eSTI² Research Consortium is developing a diagnostic self-test for STIs, to be deployed within online care-pathways. Should this intervention lead to increased STI detection and prompt effective treatment, it could reduce transmission and morbidity. Through a scoping review and three studies I explored its potential to benefit public health, thus informing the intervention’s ongoing development. The review (2013) found diverse uses of internet/electronic communications in STI care-pathways, but little research was transferable to remote self-testing or management. Current internet-use for sexual health may predict use of the proposed intervention, so I estimated its prevalence, and identified associated factors, using British probability survey data (2010-12). Among sexually-experienced 16-44-year-olds (n=8926), internet-use for STI testing/treatment was rare (<0.5%), but available services were limited. 4.5% women and 4.6% men reported internet-use for information/support with their sex-lives, elevated among the better-educated and some STI risk-groups including young people. In qualitative interviews, 25 young people at risk of STI expressed enthusiasm for a (hypothetical) STI self-test within online care-pathways. Findings informed colleagues’ development of eSTI²’s Online Chlamydia Pathway (OCP). For people requiring chlamydia treatment, this included: online automated medical assessment, a helpline, and community pharmacy treatment collection or facilitated clinic access. I undertook and thematically-analysed 40 qualitative interviews with OCP users, within pilot studies. Participants valued the rapid, convenient and discreet treatment access, increased control over their healthcare, and optional professional support by telephone, enabled by the OCP. Offline parts of the pathway (pharmacy/clinic attendance) risked compromising its perceived advantages, and require further development. Recommendations derived from an iteratively-developed understanding of this complex intervention’s use and appeal, can enhance its potential to enable STI detection and treatment, promptly, effectively and acceptably. Future evaluation must consider impacts on health inequalities.