Digital versus clinic-based sexual health services: patterns of use and equity implications from a UK-based evaluation

Clinical Snapshot

Key Findings

• P Value: Not specified in abstract

• Effect Size: Mean age difference 6.3 years (25.1 vs 31.4 years); White/mixed ethnicity groups more likely to use online services

• Primary Outcome: Demographic patterns of service utilisation between online and clinic-based sexual health services

• Nnt Or Sensitivity: STI testing uptake: 56.8% online vs 43.3% clinic-based; lower positivity rates online

• Confidence Interval: Risk ratios with 95% confidence intervals reported (specific values not provided in abstract)

Clinical Application

Digital services complement traditional care but require attention to equity gaps Relevant for Australian digital health initiatives; considerations for Medicare-funded telehealth sexual health services and ensuring equitable access across diverse populations Sexual health service users, particularly younger adults seeking STI testing and contraception

Abstract

BACKGROUND: Digital sexual health services have expanded rapidly in England; yet, concerns remain regarding equitable access among different population groups. We compared demographic characteristics and outcomes between online and clinic-based sexual health service users in Leicester, Leicestershire, and Rutland. METHODS: A retrospective analysis of data (April 2019-June 2023) compared online contacts, via SH:24, a UK online sexual health service providing postal sexually transmitted infection (STI) testing and remote contraception, with in-clinic attendances. Demographic variables included age, gender, ethnicity and Index of Multiple Deprivation (IMD 2019) decile, where Deciles 1-2 represent the most deprived areas. Ethnicity was recoded into Office for National Statistics categories. Reasons for attendance, contraception methods, and STI test outcomes were analysed. Risk ratios with 95% confidence intervals compared proportions between modalities. RESULTS: Online users were younger than clinic attendees (mean age, 25.1 vs 31.4 years). A slightly higher proportion of women accessed online services although gender was unrecorded in 59.1% of online attendances. White and mixed ethnicity groups were more likely to use online services than Black, Asian and 'Other' ethnic groups. Individuals living in the most deprived areas were less likely to access online services. STI testing was more frequent online (56.8% vs 43.3%), while positivity rates for infections were lower. CONCLUSIONS: Complementary to clinic-based sexual health services, online pathways provide accessible STI testing and contraception. Differences in uptake by age, ethnicity and deprivation highlight the importance of monitoring equitable access as digital provision expands. Maintaining both online and face-to-face provision is likely to remain important for equitable sexual health care.

References

1. 1.Robertson, F., & McGill, S. (2026). Digital versus clinic-based sexual health services: patterns of use and equity implications from a UK-based evaluation. Sexual Health. https://doi.org/10.1071/SH26077