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Aicken CRH, Wayal S, Blomquist PB, Fabiane SM, Gerressu M, Hughes G, Mercer CH. Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys. BMC Health Serv Res 2019; 19:668. [PMID: 31533716 PMCID: PMC6749649 DOI: 10.1186/s12913-019-4396-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.
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Affiliation(s)
- Catherine R. H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- School of Health Sciences, University of Brighton, Village Way, Falmer, Brighton, BN1 9PH UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Stella M. Fabiane
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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Wayal S, Aicken CRH, Griffiths C, Blomquist PB, Hughes G, Mercer CH. Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review. PLoS One 2018; 13:e0208315. [PMID: 30532145 PMCID: PMC6285827 DOI: 10.1371/journal.pone.0208315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk. METHODS Studies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS Of 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity. CONCLUSIONS Further research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Catherine R. H. Aicken
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Griffiths
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
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Gibbs J, Aicken CRH, Sutcliffe LJ, Gkatzidou V, Tickle LJ, Hone K, Sadiq ST, Sonnenberg P, Estcourt CS. Mixed-methods evaluation of a novel online STI results service. Sex Transm Infect 2018; 94:622-624. [PMID: 29326179 PMCID: PMC6288705 DOI: 10.1136/sextrans-2017-053318] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 11/02/2017] [Accepted: 12/10/2017] [Indexed: 11/23/2022] Open
Abstract
Objectives Evidence on optimal methods for providing STI test results is lacking. We evaluated an online results service, developed as part of an eSexual Health Clinic (eSHC). Methods We evaluated the online results service using a mixed-methods approach within large exploratory studies of the eSHC. Participants were chlamydia- positive and negative users of online postal self-sampling services in six National Chlamydia Screening Programme (NCSP) areas and chlamydia-positive patients from two genitourinary medicine (GUM) clinics between 21 July 2014 and 13 March 2015. Participants received a discreetly worded National Health Service ’NHS no-reply’ text message (SMS) informing them that their test results were ready and providing a weblink to a secure website. Participants logged in with their date of birth and mobile telephone or clinic number. Chlamydia-positive patients were offered online management. All interactions with the eSHC system were automatically logged and their timing recorded. Post-treatment, a service evaluation survey (n=152) and qualitative interviews (n=36) were conducted by telephone. Chlamydia-negative patients were offered a short online survey (n=274). Data were integrated. Results 92% (134/146) of NCSP chlamydia-positive patients, 82% (161/197) of GUM chlamydia-positive patients and 89% (1776/1997) of NCSP chlamydia-negative participants accessed test results within 7 days. 91% of chlamydia-positive patients were happy with the results service; 64% of those who had tested previously found the results service better or much better than previous experiences. 90% of chlamydia-negative survey participants agreed they would be happy to receive results this way in the future. Interviewees described accessing results with ease and appreciated the privacy and control the two-step process gave them. Conclusion A discreet SMS to alert users/patients that results are available, followed by provision of results via a secure website, was highly acceptable, irrespective of test result and testing history. The eSHC results service afforded users privacy and control over when they viewed results without compromising access.
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Affiliation(s)
- Jo Gibbs
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK.,Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Catherine R H Aicken
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK
| | - Lorna J Sutcliffe
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - Laura J Tickle
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, Uxbridge, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Pam Sonnenberg
- Centre for Population Research in Sexual Health and HIV, Institute of Global Health, University College London, London, UK
| | - Claudia S Estcourt
- Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.,School of Health and Life Science, Glasgow Caledonian University, Glasgow, UK
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Aicken CRH, Sutcliffe LJ, Gibbs J, Tickle LJ, Hone K, Harding-Esch EM, Mercer CH, Sonnenberg P, Sadiq ST, Estcourt CS, Shahmanesh M. Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study. Sex Transm Infect 2017; 94:241-247. [PMID: 28988193 PMCID: PMC5969326 DOI: 10.1136/sextrans-2017-053227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 08/30/2017] [Accepted: 09/07/2017] [Indexed: 11/20/2022] Open
Abstract
Objective We developed the eSexual Health Clinic (eSHC), an innovative, complex clinical and public health intervention, embedded within a specialist sexual health service. Patients with genital chlamydia access their results online and are offered medical management via an automated online clinical consultation, leading to antibiotic collection from community pharmacy. A telephone helpline, staffed by Sexual Health Advisers, is available to support patients and direct them to conventional services if appropriate. We sought to understand how patients used this ehealth intervention. Methods Within exploratory studies of the eSHC (2014–2015), we conducted in-depth interviews with a purposive sample of 36 patients diagnosed with chlamydia, who had chosen to use the eSHC (age 18–35, 20 female, 16 male). Thematic analysis was conducted. Results Participants described choosing to use this ehealth intervention to obtain treatment rapidly, conveniently and privately, within busy lifestyles that hindered clinic access. They described completing the online consultation promptly, discreetly and with ease. The information provided online was considered comprehensive, reassuring and helpful, but some overlooked it in their haste to obtain treatment. Participants generally described being able to collect treatment from pharmacies discreetly and promptly, but for some, poor awareness of the eSHC by pharmacy staff undermined their ability to do this. Those unsuitable for remote management, who were directed to clinic, described frustration and concern about health implications and clinic attendance. However, the helpline was a highly valued source of information, assistance and support. Conclusion The eSHC is a promising adjunct to traditional care. Its users have high expectations for convenience, speed and privacy, which may be compromised when transitioning from online to face-to-face elements of the eSHC. Managing expectations and improving implementation of the pharmacy process, could improve their experiences. Positive views on the helpline provide further support for embedding this ehealth intervention within a specialist clinical service.
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Affiliation(s)
- Catherine R H Aicken
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - Lorna J Sutcliffe
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Jo Gibbs
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK.,Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Laura J Tickle
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University, London, UK
| | - Emma M Harding-Esch
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK.,HIV/STI Department, National Infection Service, Public Health England, London, UK
| | - Catherine H Mercer
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
| | - S Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George's University of London, London, UK
| | - Claudia S Estcourt
- Barts and the London School of Medicine and Dentistry, Blizard Institute, Centre for Immunology and Infectious Diseases, Queen Mary University of London, London, UK.,School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, Centre for Sexual Health and HIV Research, Institute for Global Health, University College London, London, UK
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Aicken CRH, Fuller SS, Sutcliffe LJ, Estcourt CS, Gkatzidou V, Oakeshott P, Hone K, Sadiq ST, Sonnenberg P, Shahmanesh M. Young people's perceptions of smartphone-enabled self-testing and online care for sexually transmitted infections: qualitative interview study. BMC Public Health 2016; 16:974. [PMID: 27624633 PMCID: PMC5022229 DOI: 10.1186/s12889-016-3648-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 09/07/2016] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Control of sexually transmitted infections (STI) is a global public health priority. Despite the UK's free, confidential sexual health clinical services, those at greatest risk of STIs, including young people, report barriers to use. These include: embarrassment regarding face-to-face consultations; the time-commitment needed to attend clinic; privacy concerns (e.g. being seen attending clinic); and issues related to confidentiality. A smartphone-enabled STI self-testing device, linked with online clinical care pathways for treatment, partner notification, and disease surveillance, is being developed by the eSTI(2) consortium. It is intended to benefit public health, and could do so by increasing testing among populations which underutilise existing services and/or by enabling rapid provision of effective treatment. We explored its acceptability among potential users. METHODS In-depth interviews were conducted in 2012 with 25 sexually-experienced 16-24 year olds, recruited from Further Education colleges in an urban, high STI prevalence area. Thematic analysis was undertaken. RESULTS Nine females and 16 males participated. 21 self-defined as Black; three, mixed ethnicity; and one, Muslim/Asian. 22 reported experience of STI testing, two reported previous STI diagnoses, and all had owned smartphones. Participants expressed enthusiasm about the proposed service, and suggested that they and their peers would use it and test more often if it were available. Utilizing sexual healthcare was perceived to be easier and faster with STI self-testing and online clinical care, which facilitated concealment of STI testing from peers/family, and avoided embarrassing face-to-face consultations. Despite these perceived advantages to privacy, new privacy concerns arose regarding communications technology: principally the risk inherent in having evidence of STI testing or diagnosis visible or retrievable on their phone. Some concerns arose regarding the proposed self-test's accuracy, related to self-operation and the technology's novelty. Several expressed anxiety around the possibility of being diagnosed and treated without any contact with healthcare professionals. CONCLUSIONS Remote STI self-testing and online care appealed to these young people. It addressed barriers they associated with conventional STI services, thus may benefit public health through earlier detection and treatment. Our findings underpin development of online care pathways, as part of ongoing research to create this complex e-health intervention.
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Affiliation(s)
- Catherine R. H. Aicken
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Sebastian S. Fuller
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lorna J. Sutcliffe
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Claudia S. Estcourt
- Blizard Institute, Centre for Immunology and Infectious Diseases, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - Pippa Oakeshott
- Population Health Research Institute, St George’s University of London, London, UK
| | - Kate Hone
- College of Engineering, Design and Physical Sciences, Brunel University London, London, UK
| | - S. Tariq Sadiq
- Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Maryam Shahmanesh
- Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
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Aicken CRH, Fuller SS, Sutcliffe LJ, Gibbs J, Tickle L, Estcourt CS, Sonnenberg P, Mercer CH, Johnson AM, Sadiq ST, Shahmanesh M. OP34 Online care for sexually transmitted infections: using qualitative research in intervention development and evaluation. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aicken CRH, Estcourt CS, Johnson AM, Sonnenberg P, Wellings K, Mercer CH. Use of the Internet for Sexual Health Among Sexually Experienced Persons Aged 16 to 44 Years: Evidence from a Nationally Representative Survey of the British Population. J Med Internet Res 2016; 18:e14. [PMID: 26792090 PMCID: PMC4740495 DOI: 10.2196/jmir.4373] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 09/23/2015] [Accepted: 10/16/2015] [Indexed: 12/03/2022] Open
Abstract
Background Those who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery. Objective We aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one’s sex life) and to identify associated sociodemographic and behavioral factors. Methods Complex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain’s resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs). Results Recent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31%; women: 0.16%), whereas 2.35% of men and 0.51% of women reported obtaining condoms/contraceptives online. Additionally, 4.49% of men and 4.57% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7%; 35-44 years: 1.84%, P<.001; women 16-24 years: 7.8%; 35-44 years: 1.84%, P<.001). Use of information/support websites was strongly associated with men’s higher socioeconomic status (managerial/professional vs semiroutine/routine: AOR 1.93, 95% CI 1.27-2.93, P<.001). Despite no overall association with area-level deprivation, those in densely populated urban areas were more likely to report use of information/support websites than those living in rural areas (men: AOR 3.38, 95% CI 1.68-6.77, P<.001; women: AOR 2.51, 95% CI 1.34-4.70, P<.001). No statistically significant association was observed with number of sex partners reported after age adjustment, but use was more common among men reporting same-sex partners (last 5 years: AOR 2.44, 95% CI 1.27-4.70), women reporting sex with multiple partners without condoms (last year: AOR 1.90, 95% CI 1.11-3.26), and, among both sexes, reporting seeking sex online (last year, men: AOR 1.80, 95% CI 1.16-2.79; women: AOR 3.00, 95% CI 1.76-5.13). No association was observed with reporting STI diagnosis/es (last 5 years) or (after age adjustment) recent use of any STI service or non-Internet sexual health seeking. Conclusions A minority in Britain used the Internet for the sexual health reasons examined. Use of information/support websites was reported by those at greater STI risk, including younger people, indicating that demand for online STI services, and Internet-based sexual health interventions in general, may increase over time in this and subsequent cohorts. However, the impact on health inequalities needs addressing during design and evaluation of online sexual health interventions so that they maximize public health benefit.
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Affiliation(s)
- Catherine R H Aicken
- Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom.
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Aicken CRH, Sutcliffe LJ, Estcourt CS, Gibbs J, Tickle LJ, Sonnenberg P, Sadiq ST, Shahmanesh M. P12.01 Getting your chlamydia care online: qualitative study among users of the chlamydia online clinical care pathway (chlamydia-occp), in a proof of concept study. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mercer CH, Aicken CRH, Tanton C, Estcourt CS, Brook MG, Keane F, Cassell JA. Serial monogamy and biologic concurrency: measurement of the gaps between sexual partners to inform targeted strategies. Am J Epidemiol 2013; 178:249-59. [PMID: 23801013 DOI: 10.1093/aje/kws467] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Having multiple sexual partners concurrently increases the risk of transmission of a sexually transmitted infection. Even if partnerships do not overlap, transmission potential exists when the gap between partnerships is shorter than the remaining infectious period. In the present article, we quantify the gap between partners to assess transmission potential using data collected by a cross-sectional survey of 2,203 genitourinary medicine clinic patients in England in 2009. Questionnaires asked about patients' 3 most recent partnerships. Gaps were calculated as time (days) between the last sexual encounter with a former partner and the first sexual encounter with the next partner. Among 1,875 patients who reported 1 or more partners in the previous 3 months, 47.6% of men and 27.7% of women reported 2 or more partners. Forty-two percent of the gaps were negative (i.e., partnerships that were concurrent); the median gaps were -7 and -17 days for men and women, respectively (i.e., overlaps were 7 and 17 days for men and women, respectively). Although half of the gaps were positive (serially monogamous partnerships), many were of short duration; the median gaps were 14 and 24 days for men and women, respectively. In over half of the gaps, condoms were used inconsistently with one or both partners, and in one-quarter, condoms were never used with either partner. There is thus a high potential for sexually transmitted infections, as even if partnerships are not behaviorally concurrent, they may be biologically concurrent. These data have important implications for designing and targeting effective health promotion messages.
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Affiliation(s)
- Catherine H Mercer
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London WC1E 6JB, UK.
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Mercer CH, Aicken CRH, Cassell JA, Hartnell V, Davies L, Ryan J, Keane F. Not so different after all? Comparing patients attending general practice-based locally enhanced services for sexual health with patients attending genitourinary medicine. Int J STD AIDS 2013; 24:106-11. [PMID: 24400345 PMCID: PMC4138003 DOI: 10.1177/0956462412472301] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2012] [Indexed: 11/17/2022]
Abstract
We did a cross-sectional survey of patients attending genitourinary (GU) medicine clinics (n = 933) and general practice-based Locally Enhanced Services for Sexual Health (GP-LESSH, n = 111) in Cornwall, England, in 2009/2010, to compare patients' characteristics and experiences. Patients completed a pen-and-paper questionnaire that was then linked to an extract of their clinical data. GP-LESSH patients took longer both to seek and to receive care: medians of nine and seven days, respectively, versus GU medicine patients: medians of seven and one day, respectively. GP-LESSH patients were less likely than GU medicine patients to report symptoms (19.6% versus 30.6%) and sexual risk behaviours (33.3% versus 44.7% reported new partners) since recognizing needing to seek care; 5.0% versus 10.2% were men who have sex with men). However, they were equally likely to have sexually transmitted infections (STIs) diagnosed (23.3% versus 24.8%). As GP-LESSH may operate infrequently, local services must work collaboratively to ensure that those seeking care for suspected STIs receive it promptly. Failing to do so facilitates avoidable STI transmission.
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Affiliation(s)
- C H Mercer
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
| | - C R H Aicken
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
| | - J A Cassell
- UCL Centre for Sexual Health & HIV Research, 3rd floor Mortimer Market Centre off Capper Street, London WC1E 6JB
- Brighton & Sussex Medical School, Brighton
| | | | | | | | - F Keane
- Royal Cornwall Hospitals, Cornwall, UK
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Aicken CRH, Gray M, Clifton S, Tanton C, Field N, Sonnenberg P, Johnson AM, Mercer CH. Improving questions on sexual partnerships: lessons learned from cognitive interviews for Britain's third National Survey of Sexual Attitudes and Lifestyles ("Natsal-3"). Arch Sex Behav 2013; 42:173-185. [PMID: 22695641 PMCID: PMC3541929 DOI: 10.1007/s10508-012-9962-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 03/19/2012] [Accepted: 03/24/2012] [Indexed: 06/01/2023]
Abstract
Patterns of sexual partnership formation and dissolution are key drivers of sexually transmitted infection transmission. Sexual behavior survey participants may be unable or unwilling to report accurate details about their sexual partners, limiting the potential to capture information on sexual mixing and timing of partnerships. We examined how questions were interpreted, including recall strategies and judgments made in selecting responses, to inform development of a module on recent sexual partnerships in Britain's third National Survey of Sexual Attitudes and Lifestyles ("Natsal-3"). Face-to-face cognitive interviews were conducted with 14 men and 18 women aged 18-74 years, during development work for Natsal-3. People with multiple recent partners were purposively sampled and questions were presented as a computer-assisted self-interview. Participants were generally agreeable to answering questions about their sexual partners and practices. Interpretation of questions designed to measure concurrent (overlapping) partnerships was broadly consistent with the epidemiological concept of concurrency. Partners' ages, genders, ethnicity, and participants' perceptions of whether partner(s) had had concurrent partnerships were reported without offense. Recall problems and lack of knowledge were reported by some participants (of all ages), especially about former, casual, and/or new partnerships, and some reported guessing partners' ages and dates of sex. Generally, participants were able to answer questions about their sexual partners accurately, even when repeated for multiple partners. Cognitive interviews provided insight into the participants' understanding of, ability to answer, and willingness to answer questions. This enabled us to improve questions used in previous surveys, refine new questions, and ensure the questionnaire order was logical for participants.
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Affiliation(s)
- Catherine R. H. Aicken
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | | | | | - Clare Tanton
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Nigel Field
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Pam Sonnenberg
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Anne M. Johnson
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
| | - Catherine H. Mercer
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, 3rd Floor Mortimer Market Centre, off Capper Street, London, WC1E 6JB UK
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Aicken CRH, Armstrong NT, Cassell JA, Macdonald N, Bailey AC, Johnson SA, Mercer CH. Barriers and opportunities for evidence-based health service planning: the example of developing a Decision Analytic Model to plan services for sexually transmitted infections in the UK. BMC Health Serv Res 2012; 12:202. [PMID: 22805183 PMCID: PMC3519719 DOI: 10.1186/1472-6963-12-202] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 06/28/2012] [Indexed: 11/10/2022] Open
Abstract
Background Decision Analytic Models (DAMs) are established means of evidence-synthesis to differentiate between health interventions. They have mainly been used to inform clinical decisions and health technology assessment at the national level, yet could also inform local health service planning. For this, a DAM must take into account the needs of the local population, but also the needs of those planning its services. Drawing on our experiences from stakeholder consultations, where we presented the potential utility of a DAM for planning local health services for sexually transmitted infections (STIs) in the UK, and the evidence it could use to inform decisions regarding different combinations of service provision, in terms of their costs, cost-effectiveness, and public health outcomes, we discuss the barriers perceived by stakeholders to the use of DAMs to inform service planning for local populations, including (1) a tension between individual and population perspectives; (2) reductionism; and (3) a lack of transparency regarding models, their assumptions, and the motivations of those generating models. Discussion Technological advances, including improvements in computing capability, are facilitating the development and use of models such as DAMs for health service planning. However, given the current scepticism among many stakeholders, encouraging informed critique and promoting trust in models to aid health service planning is vital, for example by making available and explicit the methods and assumptions underlying each model, associated limitations, and the process of validation. This can be achieved by consultation and training with the intended users, and by allowing access to the workings of the models, and their underlying assumptions (e.g. via the internet), to show how they actually work. Summary Constructive discussion and education will help build a consensus on the purposes of STI services, the need for service planning to be evidence-based, and the potential for mathematical tools like DAMs to facilitate this.
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Abstract
BACKGROUND Intrauterine devices (IUDs) are highly effective and are the most widely used reversible contraceptive method in the world. However, in developed countries IUDs are among the least common methods of contraception used. We evaluated the effect of interventions to increase uptake of the copper IUD, a long-acting, reversible contraceptive method. OBJECTIVES To determine effectiveness of interventions to improve uptake and continuation of the copper IUD. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, POPLINE, PsycINFO, PubMed, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP) and OpenSIGLE. We also handsearched references of relevant reviews and included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and controlled before and after studies of interventions which measured use and uptake of contraception including copper IUD as an outcome. DATA COLLECTION AND ANALYSIS Two authors independently screened the search results for relevant studies and extracted data from included studies. We used RevMan 5.1 to calculate Peto odd ratios (OR) with 95% confidence intervals (CI) for dichotomous outcomes. We conducted meta-analysis by pooling data for similar types of intervention where possible. We used the GRADE system to evaluate the quality of evidence. MAIN RESULTS Nine studies representing 7960 women met our inclusion criteria, including seven randomised controlled trials and two controlled before and after studies that reported IUD uptake postintervention. We evaluated the quality of evidence as moderate to low. Three studies on contraceptive counselling and referrals by community workers showed an increase in uptake of the IUD among intervention groups (Peto OR 2.00; 95% CI 1.40 to 2.85). Two studies on antenatal contraceptive counselling also favoured the intervention groups (Peto OR 2.33; 95% CI 1.39 to 3.91). One study on postnatal couple contraceptive counselling also showed an increase in IUD uptake compared to control (Peto OR 5.73; 95% CI 3.59 to 9.15). The results of one study evaluating postnatal home visits and two studies on enhanced postabortion contraceptive counselling did not reach statistical significance. AUTHORS' CONCLUSIONS Community-based interventions and antenatal contraceptive counselling improved uptake of copper IUD contraception. Since the copper IUD is one of the most effective reversible contraceptive methods, primary care and family planning and practitioners could consider adopting these interventions. Although our review suggests these interventions are clinically effective, a cost-benefit analysis may be required to evaluate applicability.
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Affiliation(s)
- Myat E Arrowsmith
- 1Department of Primary Care and Public Health, Imperial College London, London, UK. 2University College London, Centre forSexual Health & HIV Research, London, UK.
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Mercer CH, Aicken CRH, Estcourt CS, Keane F, Brook G, Rait G, White PJ, Cassell JA. Building the bypass—implications of improved access to sexual healthcare: evidence from surveys of patients attending contrasting genitourinary medicine clinics across England in 2004/2005 and 2009. Sex Transm Infect 2011; 88:9-15. [DOI: 10.1136/sextrans-2011-050257] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Mercer CH, Aicken CRH, Brook MG, Estcourt CS, Cassell JA. Estimating the likely public health impact of partner notification for a clinical service: an evidence-based algorithm. Am J Public Health 2011; 101:2117-23. [PMID: 21940925 DOI: 10.2105/ajph.2011.300211] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We present the first evidence-based method for estimating public health and cost impacts of partner notification (PN) that takes account of sexual partnership type. METHODS Our algorithm uses routine clinical data, probability survey data, and transmission parameters. We propose 2 new epidemiological concepts to quantify PN impact: "[the] absolute reduction in onward transmission" and its reciprocal, "[the] number needed to treat to interrupt transmission" (i.e., the number of partners who need to be treated to interrupt 1 onward transmission). We demonstrate these concepts for 273 chlamydia cases diagnosed at a UK genitourinary medicine clinic. RESULTS The number needed to treat to interrupt transmission (overall, for casual partners, and for regular partners, respectively) was 1.47, 1.11, and 2.50, respectively, for men younger than 25 years; 1.60, 0.83, and 1.25, respectively, for women younger than 25 years; 2.35, 1.39, and 2.08, respectively, for men older than 25 years; and 2.14, 0.93, and 2.08, respectively, for women older than 25 years. CONCLUSIONS PN that targets casual partners, rather than regular or live-in partners, prevents more secondary transmissions per partnership; it is also more resource intensive, but the public health benefit is greater.
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Affiliation(s)
- Catherine H Mercer
- Research Department of Infection and Population Health, University College London, London, UK.
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Aicken CRH, Nardone A, Mercer CH. Alcohol misuse, sexual risk behaviour and adverse sexual health outcomes: evidence from Britain's national probability sexual behaviour surveys. J Public Health (Oxf) 2010; 33:262-71. [PMID: 20705716 DOI: 10.1093/pubmed/fdq056] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Evidence for relationships between alcohol misuse, sexual risk behaviour and adverse sexual health outcomes exists from both population-level data and studies undertaken in specific groups. We examine changes in these associations using representative data from two consecutive surveys. METHODS Probability surveys conducted in 1990/91 and again in 2000/01 involving interviews with British residents aged 16-44. RESULTS The proportion reporting being drunk as their main reason for first heterosexual intercourse increased from 2.5% among those born in 1946-49 to 6.4% of those born in 1980-84. These respondents were more likely to report intercourse before 16, that sex had occurred too soon, and contraception non-use. Usual alcohol consumption in excess of recommended limits ('heavy drinkers') was more common among those reporting larger partner numbers and unprotected sex with 2+ partners/past year but not with STD clinic attendance/diagnosis. Male heavy drinkers were more likely to report sexual function problems and female heavy drinkers using emergency contraception. The magnitude of these relationships did not significantly increase between 1990/91 and 2000/01. CONCLUSION In Britain, sexual risk behaviours and some adverse sexual health outcomes continue to be associated with excess alcohol consumption. These findings support addressing the link between alcohol misuse and sexual health in health services and through broader health promotion.
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Affiliation(s)
- Catherine R H Aicken
- Centre for Sexual Health and HIV Research, Research Department of Infection and Population Health, University College London, Mortimer Market Centre, Off Capper Street, London WC1E 6JB, UK
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