The Covid 19 impact on STI home tests and contraceptive services

21st October 2021 by Kate Ebbutt

Access to contraceptive services has taken a severe hit amid the Covid 19 pandemic, whilst demand for STI home tests increased

After more than 13 years leading the way on remote testing for sexual health, during the outbreak of Covid-19 we saw how vital our services were for our public sector partners. Anecdotally, we heard that services were struggling, and the NHS was reporting that fewer people were accessing contraception services. We wanted to find out the experiences of people trying to access these services, and how people feel about being tested online if they have symptoms. Here we talk about what we found.

We commissioned a survey of 500 women across the UK which revealed that over a quarter (29%) of women have been unable to access LARC services throughout the pandemic ¹. Meanwhile, a separate survey of 250 men and women who have tried to access sexual health services found that 46% of people would now prefer to carry out an STI test at home².

These findings imply that online sexual health testing can play its part in clearing the NHS backlog by freeing up capacity in sexual health clinics, potentially improving access to services such as LARC.

The detrimental effect of Covid-19 on contraception services

Contraception-related contacts with Sexual and Reproductive Health (SRH) services dropped by 24% in 2020/21 compared to 2019/20, a fall of 312,477 contacts ^3,4. Again, in 2019/20, there were 343,000 women using LARC as their main method of contraception at SRH services and in 2020/21 there were only 214,100, a fall of 38%^3,4.

According to NICE guidance last updated in 2019, increasing patients’ use of LARC methods plays an important role in reducing the risk of unplanned pregnancies. 

Our survey found the top reasons for the inaccessibility of LARC were reduced access to clinics because of Covid 19 (41%); and full-up appointment schedules (35%)¹. When asked what the impact of restricted access was one in eight (13%) report having to take the morning after pill as a result and 7% say they had to access abortion services¹.

The survey carried out by Censuswide also revealed unsurprisingly, a further 27% said they suffered from stress and anxiety being unable to access LARC¹. A fifth (20%), said they had to access an alternative contraception method (e.g., birth control pill) they felt less comfortable with ¹.

The rise of STI home testing

STI testing has dropped significantly over the course of the pandemic potentially causing a wave of future infections. A separate Censuswide poll that surveyed people who have had symptoms of an STI, and accessed services in the past two years, revealed that shockingly over two fifths (44%) had not been able to access their preferred place for testing.

It would seem many see the benefits to home testing with two in five (42%) reporting home tests save them time, and a third (34%) saying they find home tests more confidential². Over a third (36%) of respondents reported they felt embarrassed to visit a sexual health clinic and 20% said they would have to take time off work to attend a sexual health clinic².Interestingly, nearly 1 in 10 (9%) also reported that their nearest sexual health clinic had closed².

If they had symptoms of an STI in the future, four in five (80%) said that they are either very likely or somewhat likely to use home STI tests and nearly half, 46% said that next time they have symptoms they would prefer to carry out an STI test at home, compared with 32% who said they would visit an STI clinic next time they have symptoms ².

Delays in sexual health testing for people with symptoms potentially contributes to the spread of diseases. Almost one in four respondents (23%) said they had unprotected sex while waiting for a test². One in five (21%) also said their symptoms got worse while they were waiting for a test ².

Recent figures from Public Health England also reveal a 25% fall in sexual health screens, such as testing for gonorrhoea, chlamydia, syphilis and HIV.  Data from Preventx shows that the demand for online testing kits has increased by 50% since the pandemic began, suggesting that there has been a shift in how people access testing services.

Online sexual health testing can play its part in clearing the NHS backlog

Lesley Navaratne is Clinical director for sexual health services at Maidstone and Tunbridge Wells NHS Trust:

“Digital services are a fundamental part of how we deliver care. Although we had planned to extend our remote testing to include symptomatic infections COVID 19 accelerated this transformation.  Our patients are keen to use remote testing because it allows them to test at home reducing travel and removing any embarrassment they may feel from attending a clinic. We want to make sure that services are provided in a way which suits patients and is safe and accurate. 

“We’ve been able to change how we deliver our services and at the same time maintain face to face clinics for those who need them improving how we signpost to other services and support. I’m proud of the way our team has adapted – they are engaging with patients in new ways and the remote testing has meant we are seeing more complex cases face to face.”

Ruth Poole, CEO from Preventx said:

“Our findings indicate that a significant proportion of women struggled to access LARC throughout the pandemic. Lack of access to both LARC and sexual health testing services have had a significant impact on people and will result in a negative impact on health inequalities.

“At Preventx, we have been the UK’s trusted expert in providing online sexual health testing in partnership with the NHS and local government for the past 13 years. Our innovative digital platforms empower NHS staff to seamlessly support patients, and our in-house dedicated sexual health lab didn’t miss a beat with the surge in demand for home tests during the pandemic.

“By creating wider access to online sexual health testing, with more immediate access to treatment and care, we have been able to support the NHS to free up space in their clinics and give patients the in-person help they desperately need.”

References

1. Survey on 500 women who have tried to access LARC carried out by Censuswide on behalf of Preventx. August 2021.

2. Survey on 250 men and women who have tried to access sexual health services carried out by Censuswide on behalf of Preventx. August 2021.

3. Sexual and Reproductive Health Services, England (Contraception) 2020/21 – NHS Digital

4. Sexual and Reproductive Health Services, England (Contraception) 2019/20 – NHS Digital

5. STI rates remain a concern despite fall in 2020 – GOV.UK (www.gov.uk)