Treatment outcomes in individuals diagnosed with chlamydia in SH:24, an online sexual health service: a retrospective audit. (November 2018)

• Record Type: Journal Article
• Authors: Shanks, Sarah; Thomas, Fred; Coyle, Rachel; Black, Adam; Ardines, Elena; Holdsworth, Gillian
• Is Part Of: Lancet. Volume 392(2018)Supplement 2
• Page Start: S79
• Publication Date: 2018-11
• Subjects: Medicine -- Periodicals; Medicine -- Periodicals; Medicine; Medicine; Electronic journals; Periodicals; 610.5
• DOI: 10.1016/S0140-6736(18)32104-4
• Languages: English
• ISSNs: 0140-6736

Abstract

Abstract: Background: SH:24 is the UK's only fully integrated online sexual health service, developed between public health and National Health Service specialist services and providing testing for sexually transmitted infections, online chlamydia treatment, clinical support, and contraception. Users self-sample for chlamydia and gonorrhoea using a vulvovaginal swab (female users) or a urine sample (male), with or without pharyngeal or rectal swabs. At the time of audit SH:24 provided chlamydia home treatment in 66% SH:24 areas; 90% of users in these areas choose this option. 75% of users diagnosed with chlamydia receive home treatment; 25% are ineligible because of patient choice, unavailability of online treatment, or complex infection. We aimed to evaluate treatment outcomes in SH:24 users diagnosed with chlamydia. Methods: Clinical records of users with a positive chlamydia result in January, 2018, were reviewed. Treatment was categorised as confirmed if home treatment was dispatched or if clinic attendance was confirmed by partner clinics via the shared clinical record. Individuals whose treatment was unconfirmed were sent a follow-up SMS requesting treatment status. Analysis was carried out in Microsoft Excel 2016. Findings: Of 7079 tests, 415 (5·9%, 95% CI 5·3–6·4), were chlamydia positive; 260 (62·7%) were in female users and 155 (37·3%) in male users. The median age of users with positive tests was 23 years (IQR 20–27). Treatment status was confirmed in 331 of 415 users (79·8%, 95% CI 75·5–83·5) and unconfirmed in 84 (20·2%, 16·5–24·5), but after follow-up SMS a further 30 users confirmed receiving treatment (361 [87·0%, 83·3–90·0]), and 54 (13·0%, 10·0–16·7) had treatment unconfirmed. Interpretation: Receipt of treatment was confirmed in 87% of SH:24 users with chlamydia; this proportion is similar to results in genitourinary medicine settings but higher than those in primary care. A major advantage of the SH:24 model is rapid turnaround: 98% of users receive results within 72 h of the sample reaching the laboratory, and home treatment is received within 24 h. By comparison, results can take 1–2 weeks in traditional services. Rapid treatment reduces the infectious period and can decrease onward transmission. Our results also indicate that home chlamydia treatment is highly acceptable to service users. Follow-up SMS can support ascertainment of treatment status in users of an online service. Funding: None.