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eSHC system and online chlamydia pathway The eSHC system is an online sexual health service. The online chlamydia pathway sits within the eSHC and encompasses the various pathways that patients can follow after receiving a text allowing them to access their results up to the 2-week follow-up with a health adviser. People who did not access their results within 7 days, and patients testing positive for chlamydia who did not consent to take part in our study within 7 days, were passed back to the original testing site to be managed via traditional care pathways. eSHC=eSexual Health Clinic.
Source publication
Background: Self-directed and internet-based care are key elements of eHealth agendas. We developed a complex online clinical and public health intervention, the eSexual Health Clinic (eSHC), in which patients with genital chlamydia are diagnosed and medically managed via an automated online clinical consultation, leading to antibiotic collection f...
Citations
... Web-based services tend to offer a variation of either: (1) self-navigated pathology where online users receive an electronic pathology form and then attend an associated pathology service for sample collection; or (2) at-home self-collection where users receive a selfcollection kit by mail that they then return by post for laboratory testing. 4,5 While online STI testing offers the potential to lower service costs in publicly funded health systems 6,7 and to increase access by responding to demands for privacy and convenience, [8][9][10] 'digital first' solutions, however, present challenges for care coordination and service linkage between online testing services and in-person treatment providers. [11][12][13] Digital first enable different parts of the service pathway to be delivered in different settings (e.g. ...
Background
Web-based, testing for sexually transmitted infections (STI) is becoming increasingly available. However, treatment pathways from web-based services are often not well-coordinated, contributing to treatment delays and access gaps. This study investigated clinician perspectives on building service linkages with a new, web-based, STI testing service in Victoria, Australia.
Methods
We interviewed 16 clinicians from regional/outer metropolitan areas who are part of government-funded, primary care programs to strengthen sexual health services in Victoria. Interviews enquired about: clinician attitudes, considerations for managing referrals, compatibility with clinic systems, and broader policy/healthcare system factors.
Results
Clinicians were enthusiastic, perceived web-based services as complementary (not competition), and believed local treatment pathways were important for patient choice/access. They felt that administrative aspects of handling referrals from an online service could be managed without problems. To inform treatment, clinicians recommended that referral letters from the web-based service list all tests ordered, dates, and complete results. Tensions were raised regarding the utility and appropriateness of including treatment guidelines and pre-prepared prescriptions in referral letters. Respondents reported that most clinics did not stock injectable antibiotics, raising concerns by clinicians about potential treatment delays and privacy challenges related to patient-led procurement at pharmacies.
Conclusions
Our study suggests that clinicians are receptive to local treatment pathways being designed as part of web-based STI testing services, and strengthened service linkages could improve client access, particularly outside urban areas. Capacity-building and additional resourcing of local partner clinics may be needed to support decentralised, patient-centred treatment pathways.
... Introduction general populations rather than specifically LGBTQI+ youth (e.g., [34][35][36][37][38], risking online services not meeting the needs of LGBTQI+ youth. ...
Background. Lesbian, gay, bisexual, trans, queer, questioning, intersex, and other sexual and gender minority (LGBTQI+) youth have poor sexual and reproductive health outcomes and low uptake of sexual and reproductive healthcare (SRHC). Online SRHC and transgender healthcare could overcome known barriers to in-person SRHC, such as confidentiality concerns. Therefore, we aimed to describe existing literature on online SRHC and transgender healthcare for LGBTQI+ youth, synthesise study findings, and make recommendations for future research.
Methods. We conducted a scoping review following the Joanna-Briggs Institute methodology. Eligibility were online SRHC and transgender healthcare for LGBTQI+ youth (aged 10-35 years) in high-income countries. Search strings were framed around the eligibility criteria and 265 search terms were selected to identify published literature from nine databases. Searches were exported to Rayyan and studies screened by two reviewers. Data from included studies were extracted to Excel and analyzed descriptively.
Results: Of 91 included papers, 41 were quantitative, 26 were qualitative, and 24 were mixed methods. Seventy-one papers focused on sexual health (HIV/sexually transmitted infection (STI) prevention 52/71; HIV management 9/71; sexual health per se 9/71; and HIV stigma reduction 2/71); 3/91 on reproductive health (pregnancy prevention 2/3); 2/91 sexual and reproductive health; and 16/91 on transgender health (gender identity/transition per se 8/16; gender affirming care 8/16). Papers explored the provision of or engagement with education/information (72/91); non-clinical support (56/91, e.g., reminders for HIV/STI testing); and clinical care (18/91) for sexual health (10/18, e.g., home HIV/STI self-sampling kits 6/10) or transgender health (8/18, i.e., eConsultation with a healthcare provider 8/8). Studies targeted young men who have sex with men (62/91) for sexual health; trans and gender diverse youth (26/91) for transgender healthcare (16/26) and sexual health (14/26); LGBTQI+ youth (6/91); and young sexual minority women (4/91) for reproductive health (3/4) and sexual and reproductive health (1/4).
Conclusions: There is a large and varied literature base for online SRHC and transgender healthcare for LGBTQI+ youth. However, most research focused on sexual healthcare, particularly HIV/STI prevention, for men who have sex with men. Very little explored reproduction or sexual health other than HIV prevention. Young sexual minority women and trans and gender diverse youth are notably under-researched for online SRHC. Research is needed to understand how to enhance the potential of online healthcare for LGBTQI+ youth.
... Such healthcare includes online postal self-sampling (OPSS) for sexually transmitted infection (STI) and blood borne virus (BBV) testing (e.g., [5][6][7][8]. More complex online clinical care pathways are also in development, such as the eSexual Health Clinic for accessing STI test results and treatment (9) and ePrEP for accessing HIV prevention medication, pre-exposure prophylaxis (PrEP) (10). For many people, the initial steps to accessing sexual healthcare, both online and traditional (i.e., in-person/phone), are seeking sexual health information and support online (11)(12)(13). ...
Background
The ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this “digital doorway”. Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to: i) seeking online sexual health information and ii) seeking online sexual health support. Subsequently, we aimed to generate theory-informed recommendations to improve these access points.
Methods
The PROGRESS framework guided purposive recruitment (October 2021–April 2022) of 35 UK participants from diverse backgrounds, including 51% from the most deprived areas and 26% from minoritised ethnic groups. Semi-structured interviews and thematic analysis identified barriers and facilitators to seeking online sexual health information and support. A Behaviour Change Wheel (BCW) analysis then identified recommendations to better meet the needs of underserved populations.
Results
We found diverse barriers and facilitators. Barriers included low awareness of and familiarity with online information and support; perceptions that online information and support were unlikely to meet the needs of underserved populations; overwhelming volume of information sources; lack of personal relevancy; chatbots/automated responses; and response wait times. Facilitators included clarity about credibility and quality; inclusive content; and in-person assistance. Recommendations included: Education and Persuasion e.g., online and offline promotion and endorsement by healthcare professionals and peers; Training and Modelling e.g., accessible training to enhance searching skills and credibility appraisal; and Environmental Restructuring and Enablement e.g., modifications to ensure online information and support are simple and easy to use, including video/audio options for content.
Conclusions
Given that access to many sexual health services is now digital, our analyses produced recommendations pivotal to increasing access to wider sexual healthcare among underserved populations. Implementing these recommendations could reduce inequalities associated with accessing and using online sexual health service.
... 1 2 Common media for results delivery include short message service (SMS), email and websites, and users who receive an STI diagnosis are typically directed to a faceto-face service for contact tracing and treatmentalthough entirely online follow-up services are also emerging. [1][2][3] Figure 1 outlines the internet-based testing process. ...
Objectives
Internet-based testing for sexually transmitted infections allows individuals to order a self-sampling kit online, send samples to a central laboratory and receive their results electronically, reducing the need to attend a clinic unless for treatment. Its usage has grown rapidly in many high-income countries, such as England, where it now accounts for 44% of tests within the National Chlamydia Screening Programme. However, there is limited data on the experiences of service users, which may offer insights into low uptake and poor return rates among some high-incidence populations.
Methods
Participants were recruited via sexual health clinics and the website of an internet-based testing service. Purposive sampling was used to ensure a diversity of genders, sexualities and ethnic backgrounds were included. Semistructured interviews were conducted by phone, email and messenger services and explored participants’ perceptions and experiences of both internet-based and clinic-based testing. Data underwent thematic analysis.
Results
We interviewed 17 participants. Internet-based testing appealed to many due to the privacy and convenience it offered over clinic-based testing. Although most were positive about their experience of internet-based testing, many found the process of finger-prick blood sampling extremely challenging and this contributed to concerns from some participants that test results may be inaccurate. A minority of participants missed the opportunity that clinic-based testing offered to discuss symptoms or concerns with staff. Participants overwhelmingly found the process of receiving test results by short message service (SMS) acceptable and preferable to alternatives.
Conclusions
Internet-based testing is viewed positively by most users but uptake may be improved if providers emphasise the privacy and convenience it offers, as well as the accuracy of self-sampling. Providers should also consider measures to address user concerns around blood sampling and access to specialist advice.
... Nineteen of 26 studies were quantitative, [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] including one randomised controlled trial (RCT), 21 four were qualitative [34][35][36][37] and three were mixed methods studies. [38][39][40] Most explored established interventions (13/26), 16 24 26 28 29 39 PN is delivered by disease investigation specialists (DIS), who receive reports of new infections (infection type varies depending on the local regulations), interview the index patient and contact any reported partners. ...
... Although digital PN is acceptable and may be preferable in certain circumstances, most reported interventions focused solely on notification did not offer facilitation of sex partner management and did not assess sex partner or health economic outcomes. 22 24 39 As with non-digital PN, choices and outcomes may be more related to partner type than demographics and/or sexual behaviours. 43 Index patient and sex partner acceptability and preferences for different types of PN both digital and non-digital did not always overlap. ...
Background
Partner notification (PN) is key to the control of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital interventions have been used to facilitate PN. A scoping review was conducted to describe the interventions used, user preferences and acceptability of digital PN interventions from patient and partner perspectives.
Methods
A systematic literature search was conducted of eight databases for articles published in English, available online with digital PN outcome data. Articles were assessed using the Mixed Methods Appraisal Tool. Quantitative and qualitative data were synthesised and analysed using thematic analysis.
Results
Twenty-six articles met the eligibility criteria. Articles were heterogeneous in quality and design, with the majority using quantitative methods. Nine articles focused solely on bacterial STIs (five on syphilis; four on chlamydia), one on HIV, two on syphilis and HIV, and 14 included multiple STIs, of which 13 included HIV. There has been a shift over time from digital PN interventions solely focusing on notifying partners, to interventions including elements of partner management, such as facilitation of partner testing and treatment, or sharing of STI test results (between index patients and tested sex partners). Main outcomes measured were number of partners notified (13 articles), partner testing/consultation (eight articles) and treatment (five articles). Relationship type and STI type appeared to affect digital PN preferences for index patients with digital methods preferred for casual rather than established partner types. Generally, partners preferred face-to-face PN.
Conclusion
Digital PN to date mainly focuses on notifying partners rather than comprehensive partner management. Despite an overall preference for face-to-face PN with partners, digital PN could play a useful role in improving outcomes for certain partner types and infections. Further research needs to understand the impact of digital PN interventions on specific PN outcomes, their effectiveness for different infections and include health economic evaluations.
... 6 Some digital PN interventions additionally support online access to testing for sex partners and/or treatment (partner management). 9,10 Digital PN interventions offer several benefits including convenience, reduced time between receiving a result and notifying partners, 2 anonymous online notification without the need of a third party, 4 and ease of notifying large numbers of sex partners 11 potentially at lower cost than more traditional methods such as a healthcare professional phoning sexual partners. Digital PN interventions might also reduce the risk of intimate partner violence, 12 may increase rates of notification, 13 and may be particularly appropriate for 'one-off' sex partners. ...
... The addition of Gif/video demonstrations could take advantage of the digital medium [6]. Information and guidance on face-to-face PN, such as through pre-recorded demonstrations should also be provided [10]. Such PN demonstrations, can be complemented by short, pre-set and persuasive messages about PN containing links to health information and services, it should be possible to copy and share these easily with partners [25]. ...
Background
Partner notification (PN) is key to controlling sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital PN options (e.g. social media, short message service (SMS), emails) are promising in increasing PN behaviour. However, their implementation is often challenging and studies report varied levels of acceptability and uptake of PN, highlighting the need to optimise digital PN interventions.
Methods
A systematic review of barriers and facilitators to digital PN interventions for STIs, including HIV, across eight research databases (from 2010 to 2023) identified eight relevant studies, two of which addressed HIV. Data extraction identified 98 barriers and 54 facilitators to the use of digital PN interventions. These were synthesised into 18 key barriers and 17 key facilitators that were each deemed amenable to change. We then used the Behaviour Change Wheel approach, the Acceptability, Practicability, Effectiveness, Affordability, Side-effects and Equity criteria, and multidisciplinary expert input, to systematically develop practical recommendations to optimise digital PN.
Results
Thirty-two specific recommendations clustered around three themes. Digital PN interventions should: (1) empower and support the index patient by providing a range of notification options, accompanied by clear instructions; (2) integrate into users’ existing habits and the digital landscape, meeting contemporary standards and expectations of usability; and (3) address the social context of PN both online and offline through normalising the act of PN, combating STI-related stigma and stressing the altruistic aspects of PN through consistent messaging to service users and the public.
Conclusions
Our evidence-based recommendations should be used to optimise existing digital PN interventions and inform the co-production of new ones.
... During COVID-19, emerging mobile applications could become a useful tool to help individuals with self-care, information, and crisis management and be a resource for health professionals to use [18]. Evidence indicates that mHealth has been used to empower healthcare providers to reach vulnerable people, conduct monitoring, and provide treatment, health-related education, and counseling [19][20][21][22]. Particularly, in the rapidly evolving environment of COVID-19, mHealth applications have hada key role in reducing cases of COVID-19 [3]. ...
Introduction
With the increasing accessibility of smartphones, their use has been considered in healthcare services. Mobile applications have played a pivotal role in providing health services during COVID-19. This study is aimed at identifying the features, advantages, and disadvantages of health management mobile applications during COVID-19.
Methods
This systematic review was conducted in PubMed, Scopus, and Web of Science using the related keywords up to November 2021. The original articles in English about the health management mobile applications in COVID-19 were selected. The study selection was done by two researchers independently according to inclusion and exclusion criteria. Data extraction was done using a data extraction form, and the results were summarized and reported in related tables and figures.
Results
Finally, 12 articles were included based on the criteria. The benefits of mobile health applications for health management during COVID-19 were in four themes and 19 subthemes, and the most advantages of the application were in disease management and the possibility of recording information by users, digital tracking of calls, and data confidentiality. Furthermore, the disadvantages of them have been presented in two themes and 14 subthemes. The most common disadvantages are reduced adherence to daily symptom reports, personal interpretation of questions, and result bias.
Conclusion
The study results showed that mobile applications have been effective in controlling the prevalence of COVID-19 by identifying virus-infested environments, identifying and monitoring infected people, controlling social distancing, and maintaining quarantine. It is suggested that usability, ethical and security considerations, protection of personal information, and privacy of users be considered in application design and development.
... Smartphone app: computerised cognitive behavioural therapy (CBT) (Zachariae et al., 2016) Computerised CBT for insomnia treatment, as a fully automated, advanced algorithm-driven program or app being used without any support from a human therapist Shown to be an effective treatment with effects comparable to those found for face-to-face therapy Web app: online chlamydia pathway (OCP) (Estcourt et al., 2017) The OCP, an eSexual Health Clinic, which was an automated online clinical consultation model with electronic prescribing, partner notification, health promotion and surveillance. Enabled self-directed (including self-swabbing) online care integrated within a specialist sexual health service Authors report that the results of the study showed that this intervention was safe, feasible and acceptable Met national standards and regulatory requirements Clinical outcomes were comparable to usual care for individuals with chlamydia J. Psychosoc. ...
The World Health Organisation defines health technologies as the “application of organized knowledge and skills in the form of devices, medicines, vaccines, procedures and systems developed to solve a health problem and improve quality of lives.” Innovative health technologies have immense potential to improve human health and well-being. However, their advent does not guarantee equitable health outcomes. Not all individuals have equal access to health technologies resulting in different health outcomes for those individuals. Barriers to adoption, implementation, access, research and design can lead to exclusion and perpetuate the health inequalities already experienced by vulnerable or marginalised groups, for example those with intellectual disabilities (ID). Point of care testing (POCT) is a health technology used to monitor physical health and has been available for almost a decade. POCT is reported to be minimally invasive, can be conducted in a wide range of settings, enables shorter time to clinical decision making, improved self-management of health conditions and patient empowerment. Despite the benefits of POCT, adoption, use, awareness and research of the use of this technology in people with ID to monitor physical health appears to be scant. This article will explore the application of POCT in this group of individuals for whom evidence informs us die up to 25 years earlier when compared to the general population, and physical health disease account for the overwhelming majority of premature deaths. This is a narrative review exploring the use of POCT for physical health of people with ID.
... Of all studies, 26.7% (12 of 45) integrated digital innovations (figure 2C). [16][17][18][19][20][21][22][23][24][25][26][27] These included six with websites to obtain SS kits and/or information on test conduct, combined with notification 53 We excluded four studies where reference test was unclear/not reported. 22 31-33 See online supplemental table 3 for case positivity, sensitivity and specificity for CT/GC SS tests. ...
... 18 19 In one study with online-based ordering, kit return was 56.8% (1948 of 3428) 25 Impact of SS with digital innovations was reported in five studies. 17 20 21 24 Test uptake was high (85.3%; 110 of 129) in one study offering SS kits via text messaging. ...
... 21 In one UK study, 89.0% (93 of 105) of positive participants were linked to care, with 57.0% (60 of 105) accessing their results, consultation and treatment remotely through the website. 17 Turnaround time to treatment was same day to 24 days (median of 1 day; IQR 0-4). 17 In the same study, out of 105, 13 partners were notified and 9 received treatment. ...
Background
Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) resulted in over 200 million new sexually transmitted infections last year. Self-sampling strategies alone or combined with digital innovations (ie, online, mobile or computing technologies supporting self-sampling) could improve screening methods. Evidence on all outcomes has not yet been synthesised, so we conducted a systematic review and meta-analysis to address this limitation.
Methods
We searched three databases (period: 1 January 2000–6 January 2023) for reports on self-sampling for CT/GC testing. Outcomes considered for inclusion were: accuracy, feasibility, patient-centred and impact (ie, changes in linkage to care, first-time testers, uptake, turnaround time or referrals attributable to self-sampling).
We used bivariate regression models to meta-analyse accuracy measures from self-sampled CT/GC tests and obtain pooled sensitivity/specificity estimates. We assessed quality with Cochrane Risk of Bias Tool-2, Newcastle–Ottawa Scale and Quality Assessment of Diagnostic Accuracy Studies-2 tool.
Results
We summarised results from 45 studies reporting self-sampling alone (73.3%; 33 of 45) or combined with digital innovations (26.7%; 12 of 45) conducted in 10 high-income (HICs; n=34) and 8 low/middle-income countries (LMICs; n=11). 95.6% (43 of 45) were observational, while 4.4% (2 of 45) were randomised clinical trials.
We noted that pooled sensitivity (n=13) for CT/GC was higher in extragenital self-sampling (>91.6% (86.0%–95.1%)) than in vaginal self-sampling (79.6% (62.1%–90.3%)), while pooled specificity remained high (>99.0% (98.2%–99.5%)).
Participants found self-sampling highly acceptable (80.0%–100.0%; n=24), but preference varied (23.1%–83.0%; n=16).
Self-sampling reached 51.0%–70.0% (n=3) of first-time testers and resulted in 89.0%–100.0% (n=3) linkages to care. Digital innovations led to 65.0%–92% engagement and 43.8%–57.1% kit return rates (n=3).
Quality of studies varied.
Discussion
Self-sampling had mixed sensitivity, reached first-time testers and was accepted with high linkages to care. We recommend self-sampling for CT/GC in HICs but additional evaluations in LMICs. Digital innovations impacted engagement and may reduce disease burden in hard-to-reach populations.
PROSPERO registration number
CRD42021262950.
... LFT research has long focused on early-stage technologies; however, real-world use should be investigated, including individual, setting and system-level design considerations to ensure that end-users are linked to care 86 and that test results inform surveillance and infection-control interventions. Digital care pathways can link LFT self-tests to health systems and electronic patient records (Fig. 4), as was demonstrated by digitally linking self-sampling for chlamydia to care in a proof-ofconcept online pathway in the UK 87 . Similarly, digital tools have been integrated with community-based testing using LFTs in South Africa, increasing case detection, reporting and follow-up 88 . ...
The acceptability and feasibility of large-scale testing with lateral flow tests (LFTs) for clinical and public health purposes has been demonstrated during the COVID-19 pandemic. LFTs can detect analytes in a variety of samples, providing a rapid read-out, which allows self-testing and decentralized diagnosis. In this Review, we examine the changing LFT landscape with a focus on lessons learned from COVID-19. We discuss the implications of LFTs for decentralized testing of infectious diseases, including diseases of epidemic potential, the ‘silent pandemic’ of antimicrobial resistance, and other acute and chronic infections. Bioengineering approaches will play a key part in increasing the sensitivity and specificity of LFTs, improving sample preparation, incorporating nucleic acid amplification and detection, and enabling multiplexing, digital connection and green manufacturing, with the aim of creating the next generation of high-accuracy, easy-to-use, affordable and digitally connected LFTs. We conclude with recommendations, including the building of a global network of LFT research and development hubs to facilitate and strengthen future diagnostic resilience. The feasibility of large-scale testing with lateral flow tests has been demonstrated in the COVID-19 pandemic. This Review examines lessons learned from the COVID-19 pandemic to inform the design and bioengineering of next-generation lateral flow tests to strengthen future diagnostic resilience. Lateral flow tests (LFTs) were adopted at an unprecedented scale during the COVID-19 pandemic, enabling access to testing beyond healthcare settings.Only 0.4% of the 3 billion COVID-19 tests performed through to mid-2022 were conducted in low-income regions, raising ethical concerns and constraining our collective ability to respond to a pandemic.Key barriers to COVID-19 LFT development and adoption include lack of access to well characterized samples, limited accuracy, lack of connectivity, lack of evidence of cost-effectiveness, regulatory delays and centralized manufacturing capabilities.LFTs could also play an important part in the detection of other diseases of epidemic potential and antimicrobial resistance.Bioengineering approaches, such as the use of nano- and quantum materials, nucleic-acid-based LFTs, CRISPR and machine learning, will improve the sensitivity, specificity, multiplexing and connectivity features of LFTs.We recommend investing in an international LFT research and development hub network to spearhead the development of a pipeline of innovative bioengineering approaches to design next-generation LFTs. Lateral flow tests (LFTs) were adopted at an unprecedented scale during the COVID-19 pandemic, enabling access to testing beyond healthcare settings. Only 0.4% of the 3 billion COVID-19 tests performed through to mid-2022 were conducted in low-income regions, raising ethical concerns and constraining our collective ability to respond to a pandemic. Key barriers to COVID-19 LFT development and adoption include lack of access to well characterized samples, limited accuracy, lack of connectivity, lack of evidence of cost-effectiveness, regulatory delays and centralized manufacturing capabilities. LFTs could also play an important part in the detection of other diseases of epidemic potential and antimicrobial resistance. Bioengineering approaches, such as the use of nano- and quantum materials, nucleic-acid-based LFTs, CRISPR and machine learning, will improve the sensitivity, specificity, multiplexing and connectivity features of LFTs. We recommend investing in an international LFT research and development hub network to spearhead the development of a pipeline of innovative bioengineering approaches to design next-generation LFTs.
