{
  "abstract": "Objectives The last decade has seen a rapid increase in online postal self-sampling (OPSS) for sexually transmitted infections (STIs) in the UK. Evaluating OPSS is important to understand its uptake and use by different populations.Methods We analysed pseudonymised routine data from online sexual health providers in three case study areas (CSAs) in England, conducting descriptive analysis of the OPSS testing cascade for service users aged 16+ years who submitted an online kit order (1 January 2022 to 30 November 2022). We used logistic regression to determine crude and adjusted associations by CSA between service user characteristics and progression along the cascade.Results Of 610 876 orders submitted and kits dispatched, 51.5–78.4% of STI kits across CSAs were returned. 98.5% (n=459 304/466 392) of returned STI kits contained 1+ processable swab/urine sample. Chlamydia test positivity as a proportion of kit orders ranged from 3.7% (CSA2) to 5.7% (CSA3), with gonorrhoea test positivity ranging from 1.29% (CSA1) to 1.63% (CSA2).Return of blood samples varied from 36.3% to 65.3% and return of processable blood samples varied from 22.8% to 57.9% of orders submitted. Older people (45+ years) were more likely than younger people (16–19 years) to return a processable blood sample (CSA1-adjusted OR (aOR)=1.85, CSA2-aOR=1.48, CSA3-aOR=1.43, all p<0.001) as were those in less deprived versus those in most deprived areas (CSA1-aOR=1.24; CSA2-aOR=1.10; CSA3-aOR=1.37, all p<0.001). Women, and men who did not report sex with men (respectively), were less likely than men who have sex with men to return a processable blood sample (CSA1-aOR=0.42, 0.39; CSA2-aOR=0.75, 0.87; CSA3-aOR=0.40, 0.54, all p<0.001), as were those reporting symptoms compared with those with no symptoms (CSA1=0.75; CSA2=0.81; CSA3=0.92, all p≤0.004). Positive predictive value for HIV screening via OPSS (excluding those known to be living with HIV) ranged from 4.4% (CSA2) to 7.1% (CSA3).Conclusion We found consistent differences across CSAs in return of OPSS kits and processable blood samples by age, deprivation level, sex, sexual behaviour and symptom status. Interventions are needed to ensure that the testing pathways available meet the needs of all populations.",
  "authors": [
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Jo Gibbs"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Alison Howarth"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Anna Tostevin"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Victoria Tittle"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Oliver Stirrup"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Catherine H Mercer"
    },
    {
      "affiliations": [
        "Patient and Public Involvement, London, UK"
      ],
      "name": "David Crundwell"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Sara Day"
    },
    {
      "affiliations": [
        "Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"
      ],
      "name": "Claire Dewsnap"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, England, UK"
      ],
      "name": "Louise J Jackson"
    },
    {
      "affiliations": [
        "Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK"
      ],
      "name": "Hamish Mohammed"
    },
    {
      "affiliations": [
        "University of Birmingham, Birmingham, England, UK",
        "Birmingham City University, Birmingham, England, UK"
      ],
      "name": "Jonathan D C Ross"
    },
    {
      "affiliations": [
        "Institute of Epidemiology and Health Care, University College London, London, UK"
      ],
      "name": "Jessica Sheringham"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Ann Sullivan"
    },
    {
      "affiliations": [
        "Sandyford Sexual Health, NHS Greater Glasgow and Clyde, Glasgow, UK"
      ],
      "name": "Andew Winter"
    },
    {
      "affiliations": [
        "Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK"
      ],
      "name": "Geoff Wong"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Andrew Copas"
    },
    {
      "affiliations": [
        "Institute for Global Health, University College London, London, England, UK"
      ],
      "name": "Fiona Burns"
    }
  ],
  "title": "Factors associated with the online postal self-sampling testing cascade in England, 2022: a retrospective observational study of routinely collected service-level healthcare data",
  "uid": "1ff59fe1-bd13-50e0-bf5e-7bb6e439c895"
}