Below you will find details of publications and conference abstracts from the ASSIST study.

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Funded by the National Institute for Health and Care Research (NIHR)

This study is funded by the National Institute for Health and Care Research (NIHR) under its Health and Social Care Delivery Research Programme (Reference Number: NIHR129157). The views expressed are those of the author and not necessarily those of the NIHR or the Department of Health and Social Care.

Gibbs J, Howarth AR, Sheringham J, Jackson LJ, Wong G, Copas A, Crundwell DJ, Mercer CH, Mohammed H, Ross J, Sullivan AK, Murray E, Burns FM. Assessing the impact of online postal self-sampling for sexually transmitted infections on health inequalities, access to care and clinical outcomes in the UK: protocol for ASSIST, a realist evaluation. BMJ Open 2022;12:e067170. doi:10.1136/bmjopen-2022-067170

Lay summary: The ASSIST protocol paper gives a detailed description of how and why we are doing the research for the study.

Sumray K, Lloyd KC, Estcourt CS, Burns F, Gibbs J. Access to, usage and clinic outcomes of, online postal sexually transmitted infection services: a scoping review. Sex Transm Infect 2022; 98(7):528-535. doi: 10.1136/sextrans-2021-055376.

Lay summary: Testing for sexually transmitted infections (STIs) is often done at home instead of in clinics. People can order kits online that are posted to them, with results provided online or by text message. This work looked at ten of these online services in England. We found that most people using the kits had no symptoms when they ordered them. They also usually described themselves as White, women, over 20 years old, and from more wealthy areas. Online services tended to increase the number of people testing for STIs. People said the services were acceptable, easy, reliable, and discreet. But, groups that have more STIs and have greater need for these services are not using them as much. It's important to understand why services are not used by these groups so we can improve them for the people who need them the most.

Gibbs J, Solomon D, Jackson L, Mullick S, Burns F, Shahmanesh M. Measuring and evaluating sexual health in the era of digital health: challenges and opportunities. Sex Health 2022; 19(4): 336-345. doi: 10.1071/SH22068.

Lay summary: In this paper, we discuss the uses and potential of digital technology in sexual healthcare – identifying where it has worked well and where there is room for improvement. We give recommendations for people and organisations who provide sexual health services. We examine how digital technology could help to (i) reduce the spread of sexually transmitted infections (STIs) including HIV; (ii) increase diagnosis and treatment of STIs; and (iii) improve care and support for people with STIs. We describe the steps needed to make the most of digital technology and provide the best possible sexual healthcare for everyone across the world.

Gallego Marquez N, Howarth AR, Dema E, Burns F, Copas A, Mercer C, Sonnenberg P, Mitchell K, Field N, Gibbs J. Who accessed STI testing in Britain during the COVID-19 pandemic and how: findings from Natsal-COVID, a cross sectional quasi-representative survey. Int J STD AIDS 2024; 0(0). doi:10.1177/09564624241277582

Lay summary: During the COVID-19 pandemic, testing for sexually transmitted infections (STIs) was very often moved online. We looked at data from Natsal-COVID, an online survey of people’s sexual health experiences during the first year of lockdown, to see who was using online STI testing during the pandemic. We found that more than one third of STI testers used online testing during this time. People who used online testing were more often White, less often had anxiety, and less often had disabilities compared to people who used other non-online ways of testing. This could potentially mean that the move to online testing could create some sexual health inequalities. It will be important to research whether certain groups simply prefer not to use online testing, or whether online testing is more difficult to access for some groups.

Spence T, Howarth AR, Reid D, Sheringham J, Apea V, Crundwell D, Day S, Dewsnap C, Jackson L, Mercer CH, Mohammed H, Ross JDC, Sullivan A, Williams A, Winter A, Wong G, Burns F, Gibbs J. How does online postal self-sampling (OPSS) shape access to testing for sexually transmitted infections (STIs)? A qualitative study of service users. BMC Public Health 2024; 24(1): 2339. doi: 10.1186/s12889-024-19741-x

Lay Summary: This paper explores the experiences of 100 people who had recently tested for STIs in three English cities, which all offer both OPSS and clinic-based services. We looked at how perceptions and experiences of these services shaped how they access – or want to access – STI testing. Participants usually learned about OPSS from sexual health services, the internet or word of mouth. They often wanted to use OPSS as they felt it was easier to access, and offered more privacy than clinic-based services. Participants usually found OPSS reliable and easy to use, except for self-sampling blood from their fingertip. Despite widespread positive perceptions of OPSS, some participants had negative experiences and many wanted to be able to access clinic-based services when they had specific concerns (such as symptoms) and might benefit from a healthcare professional providing more holistic support.

Tittle V, Day S, Tostevin A, Kelly A, Spate J, Burns F, Gibbs J, Howarth A, Sullivan A. An evaluation of an online STI service across London; reviewing uptake, utility and outcomes over a four-year period. Sex Transm Infect ; accepted

Lay summary: We evaluated an online and postal sexually transmitted infection (STI) testing service called Sexual Health London (SHL) from January 2018 to March 2022. During this evaluation period, 1,476,187 STI test kits were requested by 670,293 people, providing one of the largest evaluations from an online STI testing provider in England to date. We found 4.5% had a positive chlamydia result, 1.6% had a positive gonorrhoea result, and 0.3% had a reactive HIV result. We discuss why these results might be lower than other sexual health services. We found positive chlamydia and gonorrhoea results were associated with trans women, trans men, and non binary groups and among users who collected STI test kits in person from sexual health services. More work needs to be done to better understand how populations use online and in-person sexual health services.

List of ASSIST conference abstracts

Howarth A, Tostevin A, Tittle V, et al. Factors associated with the online postal self-sampling testing cascade in England, 2022. Poster presentation at BASHH Annual Conference, Bournemouth, UK 17-19 June 2024. International Journal of STD & AIDS 2024, Vol. 35(1S) 1–157 doi: 10.1177/09564624241254949

Howarth A, Harb AK, Stirrup O, et al. Equity of online postal self-sampling for chlamydia testing in England using national surveillance data, 2015-2022. Poster presentation at BASHH Annual Conference, Bournemouth, UK 17-19 June 2024. International Journal of STD & AIDS 2024, Vol. 35(1S) 1–157 doi: 10.1177/09564624241254949

Howarth A, Tostevin A, Tittle V, et al. Factors associated with the HIV online postal self-sampling testing cascade in London, 2022 (O05) HIV Med 2024; 25(Suppl1):3-16. doi: 10.1111/hiv.13626

Spence T, Sheringham J, Howarth A, et al. Understanding disruption in sexual health through the implementation of online postal self-sampling. Oral presentation at Qualitative Health Research Network Conference, London, UK, 28-29 February 2024. BMJ Open 2024;14:doi: 10.1136/bmjopen-2024-UCL-QHRN2024.44

Howarth A, Harb AK, Stirrup O, et al. Factors associated with the uptake of online postal self-sampling for chlamydia testing in England. Poster presentation at 36th IUSTI Europe Congress, Valletta, Malta, 26-28 October 2023.

Spence T, Sheringham J, Howarth A, et al. Service user perspectives on online postal self-sampling (OPSS) for sexually transmitted infection (STI) testing: a qualitative study. Poster presentation at STI & HIV 2023 World Congress, Chicago, USA, 24-27 July 2023.

Spence T, Sheringham J, Howarth A, et al. The implementation of online postal self-sampling (OPSS) for sexually transmitted infection (STI) testing in England: staff and stakeholder perspectives. Poster presentation at STI & HIV 2023 World Congress, Chicago, USA, 24-27 July 2023.

Spence T, Sheringham J, Howarth A, et al. The implementation of online postal self-sampling (OPSS) for sexually transmitted infection (STI) testing in England: staff and stakeholder perspectives. Oral presentation at HSR UK Conference 2023, University of Birmingham, UK, 4-6 July 2023.

Gallego Marquez N, Howarth A, Dema E, et al. Differences in who accesses online STI testing services in Britain: findings from Natsal-COVID, a cross-sectional population survey (O27) Sex Transm Infect 2023; 99(Suppl1):A14-A15. DOI: 10.1136/sextrans-BASHH-2023.27. Oral presentation at BASHH Spring Conference 2023, Llandudno, North Wales, UK, 26-28 June 2023.

Spence T, Sheringham J, Howarth A, et al. Service user perspectives on online postal self-sampling (OPSS) for sexually transmitted infection (STI) testing: a qualitative study (P135) Sex Transm Infect 2023; 99(Suppl1):A88-A89. DOI: 10.1136/sextrans-BASHH-2023.173. Poster presentation at BASHH Spring Conference 2023, Llandudno, North Wales, UK, 26-28 June 2023.

Spence T, Sheringham J, Howarth A, et al. The implementation of online postal self-sampling (OPSS) for sexually transmitted infection (STI) testing in England: staff and stakeholder perspectives (P170) Sex Transm Infect 2023; 99(Suppl1):A109. DOI: 10.1136/sextrans-BASHH-2023.207. Poster presentation at BASHH Spring Conference 2023, Llandudno, North Wales, UK, 26-28 June 2023.