Dr John White, medical director at Preventx, comments on the tech challenges of scaling sexual health testing within the NHS.
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Blood sample for STI (sexually transmitted infection) test
Like many areas of healthcare, Sexual Health services are yet to recover from the impact of the pandemic, with testing for HIV at a lower level than pre-pandemic. According to statistics from the UK Health Security Agency (UKHSA), 20% fewer people tested for HIV in 2021 than in 2019.
This is thought to be due to the impact the pandemic has had on sexual health services. Temporary closure of community testing sites has led to a reduction in the number of testing appointments available. The problem has also been exacerbated by NHS workforce issues, including the redeployment of healthcare workers.
Testing is an important tool for limiting the spread of infection. Increased testing helps tackle sexually transmitted infections by identifying and encouraging people to seek appropriate treatment for an infection. Upon diagnosis, people who have tested are able to notify previous sexual partners who may also choose to get tested and are more likely to use protection when engaging in sexual activity, curbing onward transmission.
Impact of online services on HIV testing
Online services have had a significant impact on the increase in people testing for HIV. UKHSA data has shown a 32% rise in internet-based testing (423,287 to 560,130), which accounted for 98% of the HIV testing increase between 2020 and 2021.
There are a number of drivers behind this rise in online sexual health testing.
The NHS Long Term plan and DHSC’s Plan for Digital Health and Social Care set out the importance of technology on the future NHS and as part of this, we are seeing an increased focus on digital partnerships between services. This will have contributed to an increase in the availability of online testing. It is likely that the public appetite for online testing has in part also been driven by the normalisation of COVID-19 lateral flow testing.
One advantage of this shift is that online testing allows us to reach groups who are less likely to attend in-person services for a range of reasons. Examples can include people who feel uncomfortable attending a clinic or people who struggle to fit an appointment into their busy schedule.
Analysis of testing data also helps identify which populations and groups are the most at risk of an infection, allowing the development of targeted approaches.
Many people live in regional or remote areas where travel to their closest clinic presents barriers due to time, distance and cost. Online testing can help overcome these barriers, especially at the present time during a cost-of-living crisis. Giving people the choice to test online can also free up capacity in clinic for those who need an in-person appointment.
Challenges
HIV is an epidemic that impacts the lives of so many people around the world. To have a significant impact on HIV positivity rates in the UK, we must be able to implement solutions at scale. Innovative technological solutions must therefore be designed in a way that can be scaled up and rolled out across multiple Local Authority and NHS services throughout the country.
We must ensure also that people are not left behind by digital services. Recognising gaps in care and addressing the needs of populations who are unable to access online platforms for a variety of reasons involves collaboration with clinic- and community-based services. One way that online services can help is by providing testing services to large numbers of people who do not need to be seen in clinic; this can free up capacity of health care providers to enable them the time to attend to those with more complex needs and see those for whom online testing is not an option or those who prefer face-to-face care.
This is the challenge for digital providers: ensuring existing NHS systems are able to support new technological solutions. Interconnectivity with NHS systems is therefore crucial for the effective functioning of clinical partnerships.
NHS Sexual Health services also face a funding crisis and it is imperative to work closely with commissioners to help balance value for money and maintenance of choice for service users. Reinvestment in clinical services is still key to address the ongoing HIV epidemic on a background of rising STI rates post COVID.
Preventx, the UK’s largest online sexual health service provider, has been re-platforming their technology over the last few years. This has ensured interoperability and allowed them to deliver in a more agile and immediate way to over 70 local authority areas in England. This connectivity has the additional benefit of facilitating reporting back to public health systems to increase understanding of trends in uptake, as seen with the UKHSA reports. Surveillance data obtained can help to provide a more complete picture of STI/HIV rates among those ‘hidden’ to clinic-based services.
It is also important to remember that HIV is a global challenge, not a national one. Tech providers need to ensure interoperability across all systems so that digital innovation solutions can be scaled at an international level.
