Opening the digital doorway to sexual healthcare: Recommendations from a behaviour change wheel analysis of barriers and facilitators to seeking online sexual health information and support among underserved populations.

Background: The ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this "digital doorway". Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to i) seeking online sexual health information and ii) seeking online sexual health support.

Use of a five-category partner-type classification within a chlamydia and gonorrhoea service evaluation highlights opportunities for targeted partner notification to improve STI control.

Objectives: Partner notification (PN) is a key component of sexually transmitted infection control. British Association for Sexual Health and HIV guidelines now recommend partner-centred PN outcomes using a five-category partner classification (established, new, occasional, one-off, sex worker). We evaluated the reporting of partner-centred PN outcomes in two contrasting UK sexual health services.

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.

Digital interventions for STI and HIV partner notification: a scoping review.

Background: Partner notification (PN) is key to the control of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). Digital interventions have been used to facilitate PN. A scoping review was conducted to describe the interventions used, user preferences and acceptability of digital PN interventions from patient and partner perspectives.

Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation development from a nationally implemented PrEP programme.

Introduction: HIV pre-exposure prophylaxis (PrEP), in which people take HIV medication to prevent HIV acquisition, underpins global HIV transmission elimination strategies. Effective prevention needs people to adhere to PrEP and remain in care during periods of risk, but this is difficult to achieve. We undertook a process evaluation of Scotland's PrEP programme to explore barriers and facilitators to PrEP adherence and retention in care and to systematically develop evidence-based, theoretically-informed recommendations to address them.

Improving HIV pre-exposure prophylaxis (PrEP) uptake and initiation: process evaluation and recommendation development from a national PrEP program.

Background: HIV pre-exposure prophylaxis (PrEP) is key to HIV transmission elimination but implementation is challenging and under-researched. We undertook a process evaluation of the first 2years of a national PrEP program to explore barriers and facilitators to implementation and to develop recommendations to improve implementation, focusing on PrEP uptake and initiation.

Methods: Stage 1 involved semi-structured telephone interviews and focus groups (September 2018-July 2019) with geographically and demographically diverse patients seeking/using/declining/stopping PrEP (n =39), sexual healthcare professionals (n =54), community-based organisation service users (n =9) and staff (n =15) across Scotland.

Differential uptake and effects of digital sexually transmitted and bloodborne infection testing interventions among equity-seeking groups: a scoping review.

Background: Digital sexually transmitted and bloodborne infection (STBBI) testing interventions have gained popularity. However, evidence of their health equity effects remains sparse. We conducted a review of the health equity effects of these interventions on uptake of STBBI testing and explored design and implementation factors contributing to reported effects.

Accelerated partner therapy contact tracing for people with chlamydia (LUSTRUM): a crossover cluster-randomised controlled trial.

Background: Accelerated partner therapy has shown promise in improving contact tracing. We aimed to evaluate the effectiveness of accelerated partner therapy in addition to usual contact tracing compared with usual practice alone in heterosexual people with chlamydia, using a biological primary outcome measure.

Methods: We did a crossover cluster-randomised controlled trial in 17 sexual health clinics (clusters) across England and Scotland.

Priorities in the implementation of partner services for HIV/STIs in high-income nations: a narrative review of evidence and recommendations.

Partner notification (PN) remains a crucial prevention tool to reduce sexually transmitted infection (STI) transmission and prevent STI-related morbidity. Although there have been a variety of different approaches taken to facilitate the notification, testing and management of sexual contacts of STIs and HIV, there is an increasing acknowledgement that these interventions are unscalable and have relatively little impact on disease transmission. At the same time, an expanding body of evidence supports a shift in the emphasis of STI outreach-related work from an exclusive focus on PN to an approach that incorporates epidemiologic data collection, case management, and PN, an approach that is sometimes called partner services (PS).

Access to, usage and clinic outcomes of, online postal sexually transmitted infection services: a scoping review.

Background: There has been considerable expansion in online postal self-sampling (OPSS) STI services in many parts of the UK, driven by increasing demand on sexual health services and developments in diagnostics and digital health provision. This shift in service delivery has occurred against a backdrop of reduced funding and service fragmentation and the impact is unknown. We explored characteristics of people accessing and using OPSS services for STIs in the UK, the acceptability of these services and their impact on sexual health inequalities.

Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs.

Objectives: HIV prevention strategies including pre-exposure prophylaxis (PrEP) must reach all in need to achieve elimination of transmission by 2030. Mainstream provision may inadvertently exclude key populations. Incidence of HIV in people who inject drugs (PWID) in Glasgow, Scotland's largest city, is increasing, partly due to sexual transmission.

Patient delivered partner therapy for chlamydia infection is used by some general practitioners, but more support is needed to increase uptake: findings from a mixed-methods study.

Objectives: Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT.

Going beyond 'regular and casual': development of a classification of sexual partner types to enhance partner notification for STIs.

Objectives: To develop a classification of sexual partner types for use in partner notification (PN) for STIs.

Methods: A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients' willingness to engage in PN for each partner type.

Results: Five main partner types emerged from the evidence synthesis and consultation: 'established partner', 'new partner', 'occasional partner', 'one-off partner' and 'sex worker'.

How can we make self-sampling packs for sexually transmitted infections and bloodborne viruses more inclusive? A qualitative study with people with mild learning disabilities and low health literacy.

Objectives: 1.5 million people in the UK have mild to moderate learning disabilities. STIs and bloodborne viruses (BBVs) are over-represented in people experiencing broader health inequalities, which include those with mild learning disabilities.

Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study.

Objectives: To review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies.

Methods: We extracted data from national HIV databases (July 2015-June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of 'potentially preventable' infections with the sexual health clinic-based PrEP delivery model used.

Risk perception, safer sex practices and PrEP enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK.

Objectives: UK Black African/Black Caribbean women remain disproportionately affected by HIV. Although oral pre-exposure prophylaxis (PrEP) could offer them an effective HIV prevention method, uptake remains limited. This study examined barriers and facilitators to PrEP awareness and candidacy perceptions for Black African/Black Caribbean women to help inform PrEP programmes and service development.

Young people's preferences for the use of emerging technologies for asymptomatic regular chlamydia testing and management: a discrete choice experiment in England.

Objective: To undertake a comprehensive assessment of the strength of preferences among young people for attributes of emerging technologies for testing and treatment of asymptomatic chlamydia.

Design: Discrete choice experiment (DCE) with sequential mixed methods design. A staged approach to selection of attributes/levels included two literature reviews, focus groups with young people aged 16-24 years (n=21), experts' review (n=13) and narrative synthesis.

Mixed-methods evaluation of a novel online STI results service.

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.

The eSexual Health Clinic system for management, prevention, and control of sexually transmitted infections: exploratory studies in people testing for Chlamydia trachomatis.

Background: Self-directed and internet-based care are key elements of eHealth agendas. We developed a complex online clinical and public health intervention, the eSexual Health Clinic (eSHC), in which patients with genital chlamydia are diagnosed and medically managed via an automated online clinical consultation, leading to antibiotic collection from a pharmacy. Partner notification, health promotion, and capture of surveillance data are integral aspects of the eSHC.

Using the eSexual Health Clinic to access chlamydia treatment and care via the internet: a qualitative interview study.

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.