At-home testing for sexually transmitted infections (STIs) using kits ordered online may help increase uptake rates and should be considered as a complement to usual care, reported researchers.
In a randomized trial involving more than 2,000 people in London, uptake of STI testing at 6 weeks was higher among those who used “e-STI” testing compared with those who used existing services at health clinics (50.0% versus 26.6%, relative risk 1.87, 95% CI 1.63-2.15, P<0.001), wrote Emma Wilson, MSc, of the London School of Hygiene & Tropical Medicine, and colleagues online in PLOS Medicine.
“E-STI testing is currently being implemented in the U.K. as one measure to meet increasing demand for STI testing, but there is surprisingly little evidence on whether it successfully encourages uptake,” said Wilson. “Our study, the first of its kind, aimed to investigate the effectiveness of e-STI testing for syphilis, HIV, chlamydia, and gonorrhea.”
Co-author Caroline Free, MBChB, PhD, of the London School of Hygiene & Tropical Medicine, explained that while sexual health clinics play an important role in community health, some people may find them inconvenient or stigmatizing.
“Our study showed that when e-STI testing was made available alongside face-to-face services, the number of people getting tested for STIs nearly doubled,” stated Free.
Wilson and colleagues recruited 2,072 participants, ages 16–30 years, from the London boroughs of Lambeth and Southwark from Nov. 24, 2014, to Aug. 31, 2015. All participants had at least one sexual partner in the last 12 months, were willing to take an STI test, and had internet access.
The researchers randomized participants to a control group who received a text message with a link listing the locations, contact details, and websites of seven local sexual health clinics, or to e-STI testing using a service called SH:24.
Those in the latter group were directed to a website for ordering sample collection kits, which they then returned for testing for chlamydia, gonorrhea, HIV, and syphilis. Test results and information about safe sex were delivered via text message or telephone.
Participants in both groups were allowed to use other services or interventions at their discretion during the study period.
Wilson and colleagues found that 2.8% of participants in the intervention group were diagnosed with an STI compared with 1.4% in the control group. The proportion of participants treated was 1.1% versus 0.7%, respectively.
Time to test was shorter in the e-STI group compared with the control group (28.8 days versus 36.5 days, P<0.001), but there were no differences for time to treatment (83.2 days versus 83.5 days).
The researchers also reported that that among participants who completed an STI test at 6 weeks, 4.3% (19 out of 439; 95% CI 2.8%-6.7%) tested positive for an STI in the e-STI group compared with 4.6% (8 out of 173; 95% CI 2.3%-9.0%) in the control group.
“As sexual health services develop we would like to see further work aligning online and clinic based services,” commented another study author, Paula Baraitser, MSc, of Kings College London. “Going forward we advise joint commissioning of these different modalities of care to ensure that users are able to move easily from one to another according to their health care needs, allowing continuity of care.”
A leading study limitation was the inability to recruit the target of 3,000 participants, leaving the study underpowered to detect differences in STI diagnoses and STI cases treated. The team also noted the use of self-reported data, as well as that those who registered for the study already had a greater interest in STI testing compared to those who declined, thus limiting the study’s generalizability.
The study was funded by Guy’s and St Thomas’ Charity, as part of their award to SH:24.
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner