Unity Sexual Health rapid testing, diagnostic and treatment service evaluation: study protocol

Sexual health services are facing financial constraints due to reduced local authority budgets. At the same time, there is increased demand for HIV and sexually transmitted infection (STI) testing. In April 2017, Unity Sexual Health successfully bid to provide sexual health services for Bristol, North Somerset and South Gloucestershire. Unity re-designed its service to improve access and delivery of care. This includes use of new rapid STI tests, which are as good as Unity’s current laboratory tests, so patients can get results of their tests within 4 hours i.e. on the same day or next day. Currently patients and clinicians may have to wait over a week for results of tests for chlamydia and gonorrhoea.
The Unity website will direct patients to the service which best meets their needs. Asymptomatic, low risk patients will be encouraged to self-manage using the online services, including postal testing kits.
Symptomatic patients will be encouraged to attend the new rapid sexual health service at Unity Central Health Clinic. Rapid STI testing will be offered to patients who attend the clinic. This means patients will be asked to drop-off their self-taken samples (e.g. urine sample, vaginal or rectal swab) and 4 hours later (or in some cases next working day) will be asked to return for their test results and treatment, often without the need for the clinicians to examine the patients. Bloods for HIV and syphilis testing will still be sent to the laboratory for testing. For asymptomatic high risk patients such as men who have sex with men (MSM) and commercial sex workers, Unity will offer an appointment based service during which rapid HIV testing in addition to rapid STI testing will be undertaken, and vaccinations including Hepatitis B offered at the time of specimen drop off. Individuals testing positive for STIs and/or HIV will receive appropriate treatment, advice on the need for repeat testing, safer sexual practices and support in hours (previously patients had to wait over a week for their test results) reducing the need to re-attend. As most infections do not cause any symptoms, early detection and treatment can help stop onward transmission and serious disease developing such as infertility and death.

What is the aim of the project?
CLAHRC West will evaluate changes to the Unity Central Health Clinic service.

What are we doing?
We are using quantitative and qualitative methods to understand the impact of the new service on service delivery, costs and resources and to examine patients’ and clinic staff views and acceptability of the service.