Sally Corden and Zoë Couzens
Public Health Wales NHS Trust and Industry Partner, Roche
Background:
GP surgeries and Integrated Sexual Health Services are unable to support the increasing number of individuals seeking sexual health assessment and testing. Many individuals who seek these services are not infected and simply require sexual health education and reassurance.
With the development of non-invasive tests for Chlamydia and Gonorrhoea these patients do not need to see a clinician and could, therefore, access appropriate care without visiting a clinic. This frees up capacity in the specialist services to address the more urgent and complex cases.
Aims:
The aim of the project was to make Chlamydia and Gonorrhoea tests easily available to more individuals and provide rapid access to Integrated Sexual Health Services for those who require an urgent appointment, without swamping existing clinical services.
This aligns with the prudent model of health by enabling people to self-sample without attendance at a clinic. Individuals use a dry swab technique to self-test and return by standard pre-paid post. This will improve efficiency and empower users to make appropriate choices about their sexual health using tools for self-management.
By removing the need for attendance for the initial test, there is a reduction in overall cost of patient care and an improvement in efficiency. This efficiency is a result of removing asymptomatic individuals from the clinic queue (approximately 30% of patients currently seen in clinic), at a time when 10% of patients are turned away due to lack of clinic capacity and of this 10% turned away, 25% are symptomatic.
Challenges:
The main challenge was ensuring that the swab used to test for penile infection was used effectively. To address the issues of insufficient sampling the team moved to Phase 2 in the clinic where they specified the length of time to swab in the instructions.
The project team also trialled another method based on the fact that the males are usually expected to provide a urine sample. Phase 3 in the clinic was to request that males urinate on the swab.
Outcomes:
The benefits of the project include:
- Better access to information, risk assessment and sexual health promotion, including those at high risk of sexual ill health and those who find it difficult to access existing services. This places the user at the heart of care with tools for self-management.
- Making the system more efficient by redirecting less complex cases to community testing, which in turn releases capacity in existing specialist services. This allows for more complex case management whilst maintaining direct referral to specialist services for those identified in the community with more complex needs.
- Increasing access to sexual health services has been shown to improve sexual health by reducing the impact of untreated sexually transmitted infection (STI) in Wales. It is hoped that this will lead to a reduction in transmission of STIs as a result of earlier treatment
- Reduced production and disposal of hazardous waste. It is hoped that by developing a testing service that allows samples to be posted safely, transport costs will be reduced and there will be a beneficial impact on the environment.
Next steps:
The next steps are to use the sampling approach as part of a pilot providing Chlamydia and Gonorrhoea testing through online access. 1,000 tests will be provided to residents of the Hywel Dda University Health Board area.
The evaluation of the tests will continue and will inform the development of an All Wales community testing service for diagnosis of sexually transmitted infections.
