Delivering a world class online postal self-sampling service at scale for HIV and STIs

18th July 2023 by Claire Taylor

John White,1 Vanessa Apea,1 Ryan Kinsella1 and Kate Ebbutt1

1Preventx

Background

Increasing demand and limited resources, alongside diagnostic developments, have been key drivers for the expansion of online sexual health services within the UK. Remote self-sampling with centralised lab testing is an important, accessible and cost-effective way to carry out wide-spread STI and HIV testing; critical in reducing the burden of infection and achieving zero HIV transmissions by 2030.

Since 2008, a UK-based commercial organisation has partnered with the National Health Service to empower people to access reliable, trusted online testing services. It runs the largest publicly-funded online testing programme, globally. We describe their differentiated model of delivery and key outcomes.

Issue

The user follows a bespoke online consultation that recommends the most appropriate screen/tests, and personalised self-sampling kits are posted (vaginal, rectal, urine, pharyngeal, capillary blood) via in-house packing and dispatchment teams. Samples returned are processed through an in-house ISO 15189 accredited medical laboratory, embedded as part of an innovative, integrated, end-to-end technology platform. Testing via the Roche Cobas 8800® and e801 systems includes HIV (5th generation assay), Syphilis (antibody and quantitative RPR), +/- hepatitis B (surface antigen and core antibody) and hepatitis C (antibody) performed on a single 400-600μL sample, as well as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis and Mycoplasma genitalium assays; plus manual testing.

In-house management enables heightened governance and quality assurance. Results are automated and users are notified by text, with clinical teams handling reactive/positive results. Individuals with reactive test results are signposted to a local clinic for management with appropriate safeguarding procedures in place.

Results

In 2022, the laboratory tested 1,694,866 samples, carrying out 3,794,935 individual tests. On average, 6,500 tests per day are performed (3,500 serology tests, 3000 molecular tests). In 2022, 97.54% of blood samples passed the quality review check after transit to the laboratory. 99.8% positive results were reported within 72h of sample receipt and 97.8% of negative results were reported within 48h of sample receipt.

Lessons Learned

A UK organisation has developed a vertically-integrated online sexual health service, which extends from an innovative technology platform and sampling kit logistics through to in-house laboratory. This is a world-class, scalable, flexible solution which can be implemented globally.