Understanding Practical, Robust Implementation and Sustainability of Home-based Comprehensive Sexual Health Care: A Realist Review.

This review identifies which elements of home-based comprehensive sexual health care (home-based CSH) impacted which key populations, under which circumstances. A realist review of studies focused on home-based CSH with at least self-sampling or self-testing HIV and additional sexual health care (e.g.

Chatbots That Deliver Contraceptive Support: Systematic Review.

Background: A chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information; counseling; and linkages to products and services, which could improve contraceptive knowledge, attitudes, and behaviors.

Objective: This review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes, and behaviors.

Digital support for first time self-injectable contraceptive users in Nairobi, Kenya: A design evaluation.

Background: Women in Kenya have an unmet need for contraception, and self-injectable contraceptives offer a new, self-managed fertility control option. Self-injection reduces the need to travel to a facility for ongoing care, but the initial, in-person, consultation may be a barrier. Training in self-injection administration could be delivered via WhatsApp on a mobile phone.

Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis.

Background: Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey.

Objective: This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them.

Patterns of use of emergency and oral contraceptives from an online service in the United Kingdom during the COVID-19 pandemic: A quantitative study of routinely collected data.

Objectives: Our study aimed to describe users of a free online contraception service, compare online emergency contraceptive pill (ECP) users with online oral contraceptive (OC) users, and describe patterns of use of online ECP and OC over time, including transition from ECP to more effective forms of contraception.

Study Design: Analysis of routinely collected, anonymized data from a large, publicly funded, online contraceptive service in the United Kingdom from April 1, 2019 to October 31, 2021.

Results: The online service provided 77,447 prescriptions during the study period.

Improving experience of medical abortion at home in a changing therapeutic, technological and regulatory landscape: a realist review.

Objective: To inform UK service development to support medical abortion at home, appropriate for person and context.

Design: Realist review SETTING/PARTICIPANTS: Peer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion.

Effectiveness of a behavioural intervention delivered by text messages (safetxt) on sexually transmitted reinfections in people aged 16-24 years: randomised controlled trial.

Objective: To quantify the effects of a series of text messages (safetxt) delivered in the community on incidence of chlamydia and gonorrhoea reinfection at one year in people aged 16-24 years.

Design: Parallel group randomised controlled trial.

Setting: 92 sexual health clinics in the United Kingdom.

Agreement between self-reported and researcher-measured height, weight and blood pressure measurements for online prescription of the combined oral contraceptive pill: an observational study.

Objectives: To compare agreement between self-reported height, weight and blood pressure measurements submitted to an online contraceptive service with researcher-measured values and document strategies used for self-reporting.

Design: An observational study.

Setting: An online sexual health service which provided the combined oral contraceptive pill, free of charge, to users in Southeast London, England.

Photodiagnosis of genital herpes and warts: a sociomaterial perspective on users' experiences of online sexual health care.

Online sexual health services potentially transform modes of engagement with service users. We report findings from an in-depth interview study with users of a photo-diagnosis service offered by an established UK-based online sexual health service (SH:24). Adopting a sociomaterial theoretical perspective, we analyse the interviews for descriptions of health care with and through the affordances offered by SH:24.

Evaluating the use of reactivity levels to inform risk communication and improve service user experience in an HIV self-sampling service.

Objectives: This service improvement study scoped the value of using quantitative reactivity levels (RL) to introduce a two-tier counselling approach in HIV self-sampling services. The objectives were to (1) use self-reported confirmatory test results to estimate the positive predictive value (PPV) of the first-line assay and (2) to calculate the impact on the PPV and theoretical negative predictive value of a range of proposed RL thresholds, which could be used to differentiate between higher and lower reactive results.

Methods: We studied HIV testing data from a UK-based online sexual health service from 1 December 2018 to 15 July 2020.

Photodiagnosis of genital herpes and warts within a specialist online sexual health service: an observational (mixed methods) study of user experience and clinical outcomes.

Objectives: To evaluate the feasibility and acceptability of a pilot, free, online photodiagnosis service for genital herpes and warts with postal treatment delivered by a specialist digital sexual health service.

Setting: An online sexual health service available free of charge in South East London, UK.

Participants: Routinely collected data from 237 users of the pilot service during the study period and qualitative interviews with a purposive sample of 15 users.

Contraception in Person-Contraception Online (CiP-CO) cohort study.

Background: Online contraception services increasingly provide information, clinical assessment and home-delivered oral contraceptives (OCs). Evidence is lacking on the effects of online contraceptive service use on short-term contraceptive continuation.

Methods: Cohort study comparing contraceptive continuation between new users of a free-to-access online OC service in South East London with those from other, face-to-face services in the same area.

Provision of the progestogen-only pill by community pharmacies as bridging contraception for women receiving emergency contraception: the Bridge-it RCT.

Introduction: Unless women start effective contraception after using emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies that are unable to provide ongoing contraception (apart from barrier methods which have high failure rates). This means that women need an appointment with a general practitioner or at a sexual and reproductive health clinic.

Use of effective contraception following provision of the progestogen-only pill for women presenting to community pharmacies for emergency contraception (Bridge-It): a pragmatic cluster-randomised crossover trial.

Background: Unless women start effective contraception after oral emergency contraception, they remain at risk of unintended pregnancy. Most women in the UK obtain emergency contraception from community pharmacies. We hypothesised that pharmacist provision of the progestogen-only pill as a bridging interim method of contraception with emergency contraception plus an invitation to a sexual and reproductive health clinic, in which all methods of contraception are available, would result in increased subsequent use of effective contraception.

How do users of a 'digital-only' contraceptive service provide biometric measurements and what does this teach us about safe and effective online care? A qualitative interview study.

Objectives: To describe user experience of obtaining and uploading biometric measurements to a 'digital-only' contraceptive service prior to a prescription for the combined oral contraceptive (COC). To analyse this experience to inform the design of safe and acceptable 'digital-only' online contraceptive services.

Setting: An online contraceptive service available free of charge to women in South East London, UK.

Online contraceptive discussion forums: a qualitative study to explore information provision.

Background: Women in the UK spend up to 30 years avoiding pregnancy, and effective use of contraception requires detailed information and support. Online forums offer opportunities to discuss contraception with few restrictions. Analysis of these discussions may generate learning on the information needs and preferences of their users.

Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation.

Background: Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support.

Emergency contraception from the pharmacy 20 years on: a mystery shopper study.

Background: Emergency contraception (EC) was approved in the UK as a pharmacy medicine for purchase without prescription in 2001. Twenty years later we conducted a study to characterise routine practice pharmacy provision of EC.

Study Design: Mystery shopper study of 30 pharmacies in Edinburgh, Dundee and London participating in a clinical trial of contraception after EC.

Communication Strategies Used to Obtain Clinical Histories Before Remotely Prescribing Antibiotics for Postal Treatment of Uncomplicated Genital Chlamydia: Service Evaluation.

Background: Web-based services for testing of sexually transmitted infections are widely available across the United Kingdom. Remote prescriptions with medications posted home may support prompt treatment; however, the absence of face-to-face contact with clinicians raises clinical safety issues as medical history may not be accurately provided.

Objective: This service evaluation aimed to capture the use and explore the safety of 3 remote communication strategies employed within a web-based service offering remote prescriptions of antibiotics, delivered via post, for uncomplicated genital Chlamydia trachomatis.

A cohort study of the service-users of online contraception.

Background: In January 2017, the first free service providing oral contraceptive pills (OCPs) ordered online and posted home became available in the London boroughs of Lambeth and Southwark - ethnically and socioeconomically diverse areas with high rates of unplanned pregnancy. There are concerns that online services can increase health inequalities; therefore, we aimed to describe service-users according to age, ethnicity and Index of Multiple Deprivation (IMD) quintile of area of residence and to examine the association of these with repeated use.

Methods: We analysed routinely collected data from January 2017 to April 2018 and described service-users using available sociodemographic factors and information on patterns of use.

Safetxt: a safer sex intervention delivered by mobile phone messaging on sexually transmitted infections (STI) among young people in the UK - protocol for a randomised controlled trial.

Introduction: Young people aged 16 to 24 have the highest prevalence of genital chlamydia and gonorrhoea compared with other age groups and re-infection rates following treatment are high. Long-term adverse health effects include subfertility and ectopic pregnancy, particularly among those with repeated infections. We developed the safetxt intervention delivered by text message to reduce sexually transmitted infection (STI) by increasing partner notification, condom use and (STI) testing among young people in the UK.

Expanding choice through online contraception: a theory of change to inform service development and evaluation.

Background: This study presents the theory of change underpinning an intervention to provide online contraceptive care in an inner London area with high rates of unplanned pregnancy. It aims to suggest attributes of an effective service and to identify key questions for its evaluation.

Methods: Thematic analysis of an online sexual and reproductive health programme funding application and 21 semi-structured interviews with a purposive sample of stakeholders selected to provide expertise in contraception and online health.