Access To, And Usage Of, Online Postal Sexually Transmitted Infection Self-Sampling Services: A Scoping Review

Background Increasing service user demand and rising incidence of key sexually transmitted infections (STIs), alongside developments in diagnostics and digital health provision, at a time when services have faced fragmentation and reduction in funding, have resulted in a huge expansion in online postal sexually transmitted infection (STI) self-sampling services across some parts of the UK. This review aimed to explore who is accessing and using online postal self-sampling services in the UK, the acceptability of these services and whether they are exacerbating sexual health inequalities. Methods Following the PICO (Population Intervention Comparators Outcome) framework, a systematic search was conducted in nine databases in June 2020. Included studies were published between 01/2010–06/2020, in the English language, based on pre-agreed inclusion/exclusion criteria. A second reviewer carried out abstract and full text screening. 15 studies were included. Extracted data were analysed using descriptive statistics and thematic analysis. Results Study designs were heterogeneous, including quantitative, qualitative and mixed method analysis, and were therefore appraised using the Mixed Methods Appraisal Tool. Overall, studies were of good quality. However, the majority were either evaluating a single site/testing provider, were exploratory or observational. Few studies collected comprehensive demographic data. Individuals accessing online postal STI self-sampling services tended to be asymptomatic, white, women, over 20s, and from less deprived areas. These services tended to increase overall STI testing demand and access. There were varied results on whether services reduced time to treatment. Services were deemed highly acceptable if they were trustworthy, reliable, convenient, and improved patient choice. Conclusion Existing and new services must complete comprehensive evaluations to establish whether services are inclusive, accessible and address, rather than exacerbate, sexual health inequalities. Now is a critical time to identify the effectiveness of these digital health interventions given the wave of service expansions across the UK.