Five-year experience of Sexual Health London (SHL): a large, regional, online postal sexually transmitted infection (STI) testing service

18th July 2023 by Claire Taylor

Sara Day,2 Sophie Jones,2 Emma Ostridge,3 Charlotte Goward1 and Adrian Kelly4

1Preventx, 2Chelsea and Westminster Hospitals NHS Foundation Trust, 3Lloyds Pharmacy Online Doctor, 4City of London Corporation

Background

Internet services now account for >40% STI tests performed in England. Sexual Health London (SHL) is one of the largest publicly funded online postal STI testing services in the world. It’s available to London residents and commissioned by 30/33 local government authorities. SHL launched in January 2018, initially for asymptomatic STI screening, with bidirectional referral pathways to local sexual health clinics (clinics manage symptomatic or complex patients and treat/manage SHL service users who receive abnormal STI results). During the pandemic when clinic access was significantly impacted, SHL rapidly scaled up capacity, offered kits to symptomatic individuals, launched online contraception and provided a number of other adaptations. We aim to share our e-service learnings by describing SHL’s clinical and safeguarding outcomes since its launch.

Method

SHL is available to individuals aged 16 years or older who self-sample and receive testing for chlamydia, gonorrhoea, HIV, syphilis and hepatitis. SHL is operated by Preventx Ltd (laboratory and technology provider), Chelsea and Westminster Hospital Foundation Trust (oversees clinical governance including safeguarding and management of abnormal results) and Lloyds Pharmacy Online Doctor (remote chlamydia treatment and contraception provider). Individuals register for an SHL account, complete a sexual health e-questionnaire and order a test kit or contraception.

Results

Between 08/01/2018 and 13/01/2023, SHL has received 2 million kit orders, of which 78% have been returned for testing. Service users are 56% female, 43% male and 1% trans/non-binary or other gender minorities; 82% heterosexual, 17% gay/bisexual; 75% aged between 20–34yrs; 42% are from racially minoritised groups/communities. 80% of service users ordering kits are asymptomatic. >70% current orders are from returning service users. 6% kit orders are from individuals taking PrEP

Conclusion

By collaboratively commissioning a sexual healthcare model that involves online and physical clinics working cohesively within a regional network, substantial STI testing volumes were achieved and sustained access to STI testing/treatment was enabled during the pandemic. SHL demonstrated excellent clinical outcomes, patient satisfaction metrics and operational efficiencies within a resource stretched NHS. Adopting similar models of care in other regions nationally/internationally could help enhance access to sexual healthcare.