{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T04:06:32Z","timestamp":1788926792515,"version":"build-2803163510"},"reference-count":34,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T00:00:00Z","timestamp":1788825600000},"content-version":"unspecified","delay-in-days":69,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","award":["153151"],"award-info":[{"award-number":["153151"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2026,7,24]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Remote clinical consultations and online postal self-sampling are increasingly established components of sexual and reproductive healthcare provision in the UK. However, there are concerns that uptake and outcomes of remote healthcare may differ by demographic groups and so increase health inequalities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective analysis of service-level data within two case study areas (CSAs) in England and one in Wales. Primary outcomes were treatment within 6 weeks among chlamydia cases and uptake of long-acting reversible contraception (LARC) among women attending for contraceptive care. Outcomes were compared between 2019 and 2022, during which remote care use increased in all CSAs. We evaluated overall change within each CSA, and whether changes differed by age, gender and sexual behaviour, ethnicity and Index of Multiple Deprivation (IMD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analyses included 446\u2009819 individuals across 2019\u20132022. Comparing 2019 to 2022, there was a small reduction in chlamydia treatment success in CSA-A (relative risk (RR) 0.95, 95% CI 0.93 to 0.98)\u2009and small increases in CSA-B (1.12, 1.10 to 1.14)\u2009and CSA-C (1.07, 1.03 to 1.12). Changes did not significantly vary by ethnicity or IMD, but treatment success dropped for men who have sex exclusively with women in CSA-A (RR 0.88 vs 0.98 in women) and increased for 16\u201334 year-olds in CSA-B (p=0.001 across groups). LARC uptake decreased in CSA-A (RR 0.58, 95% CI 0.55 to 0.60)\u2009but increased in CSA-B (1.18, 1.15 to 1.21)\u2009and CSA-C (1.06, 1.01 to 1.11) as proportion of contraceptive care episodes, although total LARC fittings fell in all CSAs; reduction was greater in women aged 35\u201349 in CSA-A (p&lt;0.001) and increase was greater in women 16\u201334 in CSA-B (p&lt;0.001). There was limited evidence for differences by ethnicity or IMD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study areas varied in their implementation of remote care and healthcare outcomes, but we found no strong evidence that changes in provision of remote care were associated with increases in health inequity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2025-004787","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:25:18Z","timestamp":1788924318000},"page":"e004787","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Evaluating the impact of remote care in sexual and reproductive health services on outcomes and health inequalities in the UK: a retrospective observational study of routine service-level data"],"prefix":"10.1136","volume":"4","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8705-3281","authenticated-orcid":false,"given":"Oliver","family":"Stirrup","sequence":"first","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Gallego Marquez","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Tostevin","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Josh","sequence":"additional","affiliation":[{"name":"PPIE Lead, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen","family":"Munro","sequence":"additional","affiliation":[{"name":"Hywel Dda University Health Board, Carmarthen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melvina","family":"Woode Owusu","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Solomon","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Iestyn","family":"Williams","sequence":"additional","affiliation":[{"name":"Health Services Management Centre, School of Social Policy and Society, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8968-5963","authenticated-orcid":false,"given":"Andrew","family":"Copas","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Burns","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan DC","family":"Ross","sequence":"additional","affiliation":[{"name":"Birmingham City University, Birmingham, UK"},{"name":"University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise J","family":"Jackson","sequence":"additional","affiliation":[{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo","family":"Gibbs","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,9,8]]},"reference":[{"key":"2026090820251006000_4.3.e004787.1","unstructured":"Geneva: World Health Organization . Guidelines for the management of asymptomatic sexually transmitted infections. 2025. Available: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/d5869a37-9b00-4ce9-9111-b4b3f1c19b30\/content [Accessed 7 Nov 2025]."},{"key":"2026090820251006000_4.3.e004787.2","unstructured":"Geneva: World Health Organization . Recommendations on the delivery of health services for the prevention and care of sexually transmitted infections, 2025. Available: https:\/\/iris.who.int\/server\/api\/core\/bitstreams\/c3bc57a6-0bb0-4c2c-b4a6-8bd5025ccd7a\/content [Accessed 7 Nov 2025]."},{"key":"2026090820251006000_4.3.e004787.3","unstructured":"Robertson R , Wenzel L . Understanding nhs financial pressures. 2017. Available: https:\/\/www.kingsfund.org.uk\/insight-and-analysis\/reports\/understanding-nhs-financial-pressures [Accessed 7 Nov 2025]."},{"key":"2026090820251006000_4.3.e004787.4","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-12-1095","article-title":"Internet testing for Chlamydia trachomatis in England, 2006 to 2010","volume":"12","author":"Woodhall","year":"2012","journal-title":"BMC Public Health"},{"key":"2026090820251006000_4.3.e004787.5","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2025.101412","article-title":"Uptake, positivity, and equity of online postal self-sampling for chlamydia testing in England: a retrospective cohort study","volume":"56","author":"Howarth","year":"2025","journal-title":"Lancet Reg Health Eur"},{"key":"2026090820251006000_4.3.e004787.6","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2024-056232"},{"key":"2026090820251006000_4.3.e004787.7","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2024-056309"},{"key":"2026090820251006000_4.3.e004787.8","unstructured":"UK Health Security Agency . Sexually transmitted infections and screening for chlamydia in england: 2024 report. 2025."},{"key":"2026090820251006000_4.3.e004787.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0212420","article-title":"Online testing for sexually transmitted infections: A whole systems approach to predicting value","volume":"14","author":"Turner","year":"2019","journal-title":"PLoS One"},{"key":"2026090820251006000_4.3.e004787.10","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2016-052718.263","article-title":"P215\u2005Patient telephone consultations in a sexual health service. What do they tell us about service efficiency and patient need?: Abstract P215 Table 1","volume":"92","author":"Symonds","year":"2016","journal-title":"Sex Transm Infect"},{"key":"2026090820251006000_4.3.e004787.11","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2017-101883"},{"key":"2026090820251006000_4.3.e004787.12","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2019-054130"},{"key":"2026090820251006000_4.3.e004787.13","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.1016\/S2468-2667(21)00253-X","article-title":"Initial impacts of the COVID-19 pandemic on sexual and reproductive health service use and unmet need in Britain: findings from a quasi-representative survey (Natsal-COVID)","volume":"7","author":"Dema","year":"2022","journal-title":"Lancet Public Health"},{"key":"2026090820251006000_4.3.e004787.14","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1071\/SH18127","article-title":"New digital media interventions for sexual health promotion among young people: a systematic review","volume":"16","author":"Wadham","year":"2019","journal-title":"Sex Health"},{"key":"2026090820251006000_4.3.e004787.15","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055376"},{"key":"2026090820251006000_4.3.e004787.16","unstructured":"Public Health England . The impact of the covid-19 pandemic on prevention, testing, diagnosis and care for sexually transmitted infections, hiv and viral hepatitis in England. 2020."},{"key":"2026090820251006000_4.3.e004787.17","unstructured":"Patterson S , Rennie N , Mann S , et al . Preference for Face-to-Face Contraceptive Service Delivery Post-COVID-19 Pandemic: A Cross-Sectional Study. BJOG: An International Journal of Obstetrics & Gynaecology 2025."},{"key":"2026090820251006000_4.3.e004787.18","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.o2766","article-title":"Sexual health services are at \u201cbreaking point\u201d after \u00a31bn in cuts since 2015","volume":"379","author":"Waters","year":"2022","journal-title":"BMJ"},{"key":"2026090820251006000_4.3.e004787.19","unstructured":"Local Government Association . Derby and derbyshire: tackling the fragmentation of the sexual health system. 2023."},{"key":"2026090820251006000_4.3.e004787.20","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1003333","article-title":"Impact of a pay-for-performance scheme for long-acting reversible contraceptive (LARC) advice on contraceptive uptake and abortion in British primary care: An interrupted time series study","volume":"17","author":"Ma","year":"2020","journal-title":"PLoS Med"},{"key":"2026090820251006000_4.3.e004787.21","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2022-067170","article-title":"Assessing the impact of online postal self-sampling for sexually transmitted infections on health inequalities, access to care and clinical outcomes in the UK: protocol for ASSIST, a realist evaluation","volume":"12","author":"Gibbs","year":"2022","journal-title":"BMJ Open"},{"key":"2026090820251006000_4.3.e004787.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.lanepe.2025.101541","article-title":"Sexually transmitted infection testing and key outcomes following implementation of online postal self-sampling into sexual health services in England: a retrospective observational study of routinely collected service-level healthcare data","volume":"61","author":"Gibbs","year":"2026","journal-title":"Lancet Reg Health Eur"},{"key":"2026090820251006000_4.3.e004787.23","unstructured":"UK Government Office for Health Improvement and Disparities . Sexual and reproductive health profiles: statistical commentary, march 2025. 2025."},{"key":"2026090820251006000_4.3.e004787.24","unstructured":"National Institute for Health and Care Research . The connect study: understanding the impact of remote consultations in sexual and reproductive health services on health inequalities. 2023. Available: https:\/\/fundingawards.nihr.ac.uk\/award\/NIHR153151 [Accessed 7 Nov 2025]."},{"key":"2026090820251006000_4.3.e004787.25","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1177\/09564624231180641","article-title":"STI testing, diagnoses and online chlamydia self-sampling among young people during the first year of the COVID-19 pandemic in England","volume":"34","author":"Sonubi","year":"2023","journal-title":"Int J STD AIDS"},{"key":"2026090820251006000_4.3.e004787.26","unstructured":"Office for National Statistics . Ethnic group, national identity and religion - Office for National Statistics, Available: https:\/\/www.ons.gov.uk\/methodology\/classificationsandstandards\/measuringequality\/ethnicgroupnationalidentityandreligion [Accessed 7 Nov 2025]."},{"key":"2026090820251006000_4.3.e004787.27","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1002479","article-title":"Internet-accessed sexually transmitted infection (e-STI) testing and results service: A randomised, single-blind, controlled trial","volume":"14","author":"Wilson","year":"2017","journal-title":"PLoS Med"},{"key":"2026090820251006000_4.3.e004787.28","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2023-055749"},{"key":"2026090820251006000_4.3.e004787.29","doi-asserted-by":"publisher","DOI":"10.1177\/0956462418767180"},{"key":"2026090820251006000_4.3.e004787.30","doi-asserted-by":"crossref","first-page":"985","DOI":"10.2105\/AJPH.2022.306835","article-title":"Rapid Uptake of Testing for Chlamydia, Gonorrhea, and HIV From an Online Platform, April-October 2020","volume":"112","author":"Melendez","year":"2022","journal-title":"Am J Public Health"},{"key":"2026090820251006000_4.3.e004787.31","unstructured":"UK Government . Sexual and reproductive health services, england (contraception), 2023-24. 2024."},{"key":"2026090820251006000_4.3.e004787.32","doi-asserted-by":"publisher","DOI":"10.1136\/jfprhc-2017-101728"},{"key":"2026090820251006000_4.3.e004787.33","doi-asserted-by":"crossref","DOI":"10.2196\/jmir.5911","article-title":"Screening for Child Sexual Exploitation in Online Sexual Health Services: An Exploratory Study of Expert Views","volume":"19","author":"Spencer-Hughes","year":"2017","journal-title":"J Med Internet Res"},{"key":"2026090820251006000_4.3.e004787.34","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1177\/09564624241286926","article-title":"Sexual and domestic violence enquiry: A national exploratory survey of asking and telling in sexual health services in the UK","volume":"36","author":"Meyrick","year":"2025","journal-title":"Int J STD AIDS"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2025-004787","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T03:25:25Z","timestamp":1788924325000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2025-004787"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9,8]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bmjph-2025-004787"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2025-004787","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}