{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T18:06:29Z","timestamp":1784052389576,"version":"3.55.0"},"reference-count":21,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T00:00:00Z","timestamp":1783987200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002001","name":"Health Services and Delivery Research Programme","doi-asserted-by":"publisher","award":["129157"],"award-info":[{"award-number":["129157"]}],"id":[{"id":"10.13039\/501100002001","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2026,3,29]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The last decade has seen a rapid increase in online postal self-sampling (OPSS) for sexually transmitted infections (STIs) in the UK. Evaluating OPSS is important to understand its uptake and use by different populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed pseudonymised routine data from online sexual health providers in three case study areas (CSAs) in England, conducting descriptive analysis of the OPSS testing cascade for service users aged 16+ years\u2009who submitted an online kit order (1 January 2022 to 30 November 2022). We used logistic regression to determine crude and adjusted associations by CSA between service user characteristics and progression along the cascade.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 610\u2009876 orders submitted and kits dispatched, 51.5\u201378.4% of STI kits across CSAs were returned. 98.5% (n=459\u2009304\/466 392) of returned STI kits contained 1+ processable swab\/urine sample. Chlamydia test positivity as a proportion of kit orders ranged from 3.7% (CSA2) to 5.7% (CSA3), with gonorrhoea test positivity ranging from 1.29% (CSA1) to 1.63% (CSA2).<\/jats:p>\n                    <jats:p>Return of blood samples varied from 36.3% to 65.3%\u2009and return of processable blood samples varied from 22.8% to 57.9% of orders submitted. Older people (45+ years) were more likely than younger people (16\u201319 years) to return a processable blood sample (CSA1-adjusted OR (aOR)=1.85, CSA2-aOR=1.48, CSA3-aOR=1.43, all p&lt;0.001) as were those in less deprived versus those in most deprived areas (CSA1-aOR=1.24; CSA2-aOR=1.10; CSA3-aOR=1.37, all p&lt;0.001). Women, and men who did not report sex with men (respectively), were less likely than men who have sex with men to return a processable blood sample (CSA1-aOR=0.42, 0.39; CSA2-aOR=0.75, 0.87; CSA3-aOR=0.40, 0.54, all p&lt;0.001), as were those reporting symptoms compared with those with no symptoms (CSA1=0.75; CSA2=0.81; CSA3=0.92, all p\u22640.004). Positive predictive value for HIV screening via OPSS (excluding those known to be living with HIV) ranged from 4.4% (CSA2) to 7.1% (CSA3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We found consistent differences across CSAs in return of OPSS kits and processable blood samples by age, deprivation level, sex, sexual behaviour and symptom status. Interventions are needed to ensure that the testing pathways available meet the needs of all populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056804","type":"journal-article","created":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:20:29Z","timestamp":1784049629000},"page":"sextrans-2025-056804","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Factors associated with the online postal self-sampling testing cascade in England, 2022: a retrospective observational study of routinely collected service-level healthcare data"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5696-0260","authenticated-orcid":false,"given":"Jo","family":"Gibbs","sequence":"first","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0597-6614","authenticated-orcid":false,"given":"Alison","family":"Howarth","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Tostevin","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1345-4613","authenticated-orcid":false,"given":"Victoria","family":"Tittle","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8705-3281","authenticated-orcid":false,"given":"Oliver","family":"Stirrup","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4220-5034","authenticated-orcid":false,"given":"Catherine H","family":"Mercer","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Crundwell","sequence":"additional","affiliation":[{"name":"Patient and Public Involvement, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6457-3877","authenticated-orcid":false,"given":"Sara","family":"Day","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8162-6547","authenticated-orcid":false,"given":"Claire","family":"Dewsnap","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8492-0020","authenticated-orcid":false,"given":"Louise J","family":"Jackson","sequence":"additional","affiliation":[{"name":"University of Birmingham, Birmingham, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2060-7286","authenticated-orcid":false,"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[{"name":"Blood Safety, Hepatitis, STIs and HIV Division, UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan D C","family":"Ross","sequence":"additional","affiliation":[{"name":"University of Birmingham, Birmingham, England, UK"},{"name":"Birmingham City University, Birmingham, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Sheringham","sequence":"additional","affiliation":[{"name":"Institute of Epidemiology and Health Care, University College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andew","family":"Winter","sequence":"additional","affiliation":[{"name":"Sandyford Sexual Health, NHS Greater Glasgow and Clyde, Glasgow, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geoff","family":"Wong","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, 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, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9105-2441","authenticated-orcid":false,"given":"Fiona","family":"Burns","sequence":"additional","affiliation":[{"name":"Institute for Global Health, University College London, London, England, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,14]]},"reference":[{"key":"2026071410202385000_sextrans-2025-056804v1.1","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":"2026071410202385000_sextrans-2025-056804v1.2","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":"2026071410202385000_sextrans-2025-056804v1.3","unstructured":"Sexually transmitted infections and screening for Chlamydia in England: 2024 report. 2024. Available: https:\/\/www.gov.uk\/government\/statistics\/sexually-transmitted-infections-stis-annual-data-tables\/sexually-transmitted-infections-and-screening-for-chlamydia-in-england-2024-report"},{"key":"2026071410202385000_sextrans-2025-056804v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2021-055376"},{"key":"2026071410202385000_sextrans-2025-056804v1.5","doi-asserted-by":"crossref","DOI":"10.1136\/sextrans-2017-053232.16","article-title":"O16\u2005Acceptability, uptake and impact of online home-sampling for stis in hampshire, UK: a service evaluation","volume":"93","author":"Williams","year":"2017","journal-title":"Sex Transm Infect"},{"key":"2026071410202385000_sextrans-2025-056804v1.6","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2024-056232"},{"key":"2026071410202385000_sextrans-2025-056804v1.7","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2017-017978","article-title":"Observational study of factors associated with return of home sampling kits for sexually transmitted infections requested online in the UK","volume":"7","author":"Manavi","year":"2017","journal-title":"BMJ Open"},{"key":"2026071410202385000_sextrans-2025-056804v1.8","doi-asserted-by":"crossref","DOI":"10.2196\/17667","article-title":"Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research","volume":"22","author":"Spence","year":"2020","journal-title":"J Med Internet Res"},{"key":"2026071410202385000_sextrans-2025-056804v1.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-19741-x","article-title":"How does online postal self-sampling (OPSS) shape access to testing for sexually transmitted infections (STIs)? A qualitative study of service users","volume":"24","author":"Spence","year":"2024","journal-title":"BMC Public Health"},{"key":"2026071410202385000_sextrans-2025-056804v1.10","doi-asserted-by":"publisher","DOI":"10.1177\/0956462419900461"},{"key":"2026071410202385000_sextrans-2025-056804v1.11","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":"2026071410202385000_sextrans-2025-056804v1.12","doi-asserted-by":"crossref","DOI":"10.2196\/72812","article-title":"Evaluating the Implementation of Online Postal Self-Sampling for Sexually Transmitted Infections in England: Multisite Qualitative Study","volume":"27","author":"Spence","year":"2025","journal-title":"J Med Internet Res"},{"key":"2026071410202385000_sextrans-2025-056804v1.13","doi-asserted-by":"crossref","first-page":"101541","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":"The Lancet Regional Health - Europe"},{"key":"2026071410202385000_sextrans-2025-056804v1.14","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/hiv.12634","article-title":"Using behavioural insights to increase HIV self-sampling kit returns: a randomized controlled text message trial to improve England\u2019s HIV self-sampling service","volume":"PubMed PMID","author":"Brown","year":"2018","journal-title":"HIV Med"},{"key":"2026071410202385000_sextrans-2025-056804v1.15","article-title":"Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study","volume":"18","author":"Dodds","year":"2018","journal-title":"BMC Public Health"},{"key":"2026071410202385000_sextrans-2025-056804v1.16","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1177\/03085759231203019","article-title":"\u201cI probably wouldn\u2019t want to talk about anything too personal\u201d: A qualitative exploration of how issues of privacy, confidentiality and surveillance in the home impact on access and engagement with online services and spaces for care-experienced young people","volume":"47","author":"Stabler","year":"2023","journal-title":"Adopt Foster"},{"key":"2026071410202385000_sextrans-2025-056804v1.17","doi-asserted-by":"publisher","DOI":"10.1136\/sextrans-2020-054488"},{"key":"2026071410202385000_sextrans-2025-056804v1.18","unstructured":"HIV action plan for England, 2025 to 2030. 2025. Available: https:\/\/www.gov.uk\/government\/publications\/hiv-action-plan-for-england-2025-to2030\/hiv-action-plan-for-england-2025-to-2030"},{"key":"2026071410202385000_sextrans-2025-056804v1.19","unstructured":"BHIVA\/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP)-BHIVA. 2018. Available: https:\/\/bhiva.org\/clinical-guideline\/PrEP-guidelines\/"},{"key":"2026071410202385000_sextrans-2025-056804v1.20","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-015-1200-x","article-title":"How online sexual health services could work; generating theory to support development","volume":"15","author":"Baraitser","year":"2015","journal-title":"BMC Health Serv Res"},{"key":"2026071410202385000_sextrans-2025-056804v1.21","first-page":"1","article-title":"An evaluation of the outcomes of an online HIV testing service to inform risk communication and future online testing policy","volume":"30","author":"Tang","year":"2019","journal-title":"Int J STD AIDS"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056804","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T17:20:32Z","timestamp":1784049632000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056804"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,14]]},"references-count":21,"alternative-id":["10.1136\/sextrans-2025-056804"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056804","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,14]]}}}