Personalisation of STI testing
We asked:
"Do you support a more personalised offer to sexually transmitted infections (STI) online testing across the City of York based on an individual’s level risk and history?"
68% of the respondents agreed and supported the more personalised approach to STI testing.
| Response | % of respondents |
|---|---|
| Yes | 68% |
| No | 13.3% |
| Don't know | 18% |
Over a quarter of the respondents didn’t answer the question. 25 people added comments to support their answer.
Some concerns were raised regarding:
- access to online services is difficult for some service users who don’t have internet access, others argued that this was the most efficient and convenient method of access; if a risk assessment is based on answers to set questions a diagnosis may be missed
- some suggested charging a fee for tests if these are excessively used
- service user should always have the right to speak to someone and ask for tests if they feel they require it
- everyone should have access to testing
- a number of people didn’t fully understand the question
Reason behind suggesting this approach
Online testing has a significant part to play in the testing for STIs, however many people “over test” - that is they test too frequently - this means there hasn’t been enough time between putting themselves at risk and requesting a test - which may result in a false negative, or they have not put themselves at risk of contracting an STI. This type of testing costs a significant amount of the budget available and doesn’t address some of the underlying factors or address the issue of prevention.
By asking questions regarding an individual’s sexual history, regardless of age or sexual orientation, a very clear risk assessment can be done and access to those who require tests will be given. This mirrors the procedure conducted in clinic.
If someone, through risk assessment, does not qualify for testing, they may phone the sexual health service for advice. The reasons why tests have been refused can be given and information on how to prevent themselves being placed at risk to STIs can be explained.
Sexual health needs vary according to factors such as age, gender, sexual orientation and ethnicity. However, there are certain core needs common to everyone, including high-quality information and education enabling people to make informed responsible decisions, and access to high-quality services, treatment and interventions.
The importance of prevention interventions that support and build personal resilience, and self-esteem and promote healthy choices, is part of commissioning effective services, regardless of age, sexual orientation and lifestyle.
We need to support people to become more aware of the impact of their behaviours on their health and encourage them to put preventative measures in place, taking personal responsibility - use of a condom, limiting sexual partners, reducing risky sexual behaviours and practices.
The reality is that people request the most comprehensive tests available to test for STIs that they are not at risk of contracting, these are also the most expensive and are a poor use of limited resources. Many tests are ordered and delivered but not returned. The online tests that are returned have a very low positivity rate, which may indicate that the individual has not put themselves at risk and ordered a test for reassurance.
Testing is part of a selection of options to reduce the risk of STIs. Primarily the use of condoms can reduce the risk of STI transmission. We would encourage condom use and have increased our provision of online ordering for condoms to support this approach.
Payment for tests wanted over and above clinical advice is not something that we can implement, this is a national consideration to be made by the NHS. However, patients can order and pay for STI tests from private providers - available online if they wish.
You said:
A more personalised online approach is acceptable but with options for individuals to question the decision made.
We did:
Check the information given at the point of requesting an online test. What to do if you are refused a test and how to contact the service. To clarify everyone has access to testing should they require it following a clinical assessment, this follows the process implemented across the NHS.