The role of digital technologies in sexual health. Dr. Tom Nadarzynski Research Lead in Sexual Health (University of Southampton & Solent NHS Trust)
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1 The role of digital technologies in sexual health Dr. Tom Nadarzynski Research Lead in Sexual Health (University of Southampton & Solent NHS Trust)
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17 Sexual health & Technology
18 Key facts World-wide: ~340 mil cases of STI per year (1mil per day) STIs rank in the top 5 disease categories for which adults in developing countries seek healthcare (as common as malaria) England: 434,456 new STI cases in England (2015) 3.4% decrease from 2014 Peak age: for women and for men 10% of treated young people will be re-infected within 1 year Hard-to-reach populations (MSM and BME) most affected
19 Hard-to-reach Erosion of gay-community venues Traditional gay-spaces enjoyed by straight individuals Low visibility of gay-friendly health services (disclosure) Austerity pushes people to stay at home (chemsex) Gay bars and pubs replaced by virtual hook-up apps and sex clubs Black and ethnic minority groups Barriers to doctor-patient communication (language) Physical barriers to accessing healthcare Embarrassment Services are seen as culturally insensitive
20 World Health Organisation calls for comprehensive education and behavioural support for sexual health using the most effective communication channels (WHO, 2016) Public Health England to address health inequalities by developing culturally appropriate models of service provision and health promotion. (PHE, 2015)
21 Sexual Health Interventions Community-based School-based Clinic-based Digital
22 Health Promotion: websites
23 HIV prevention: Self-sourced PrEP
24 Health Promotion: Video-blogs
25 Health Promotion: Social Media
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27 Crowdsourcing
28 Health Promotion: Phone Applications
29 Geo-positioning or Geo-targetting
30 Video consultations: Web-chats
31 Screening: STI home-sampling
32 Screening: STI home-sampling
33 What is the evidence so far?
34 19 RTCs (interactive sites, CDs, video-blogs) Moderate effect on sexual health knowledge No effect on safe sex intentions No effect on biological outcomes
35 51 studies (Facebook, YouTube, Twitter) Moderate effect on sexual health knowledge Increase in STI testing, condom use and service utilisation Reduction in chlamydia and gonorrhoea
36 Facebook page (signs, symptoms, prevention etc) 23% increase in condom utilisation 54% reduction in positive chlamydia cases
37 Clustered RCT (Facebook page with SH news) Increased, more consistent condom use (68% vs 56%) But, no effect seen over six months!
38 Facebook advertisement promoting the HPV vaccine 50% unvaccinated women received the vaccine after targeted advertising (vs 19% from standard advertising) Facebook is a cost-effective way of recruiting participants
39 Digital interventions increase knowledge about STI But do not necessarily lead to changes in behaviours Interventions conducted on social media boost STI testing and condom use, but the effect is gone after a few months Users need to be actively involved in the process of developing digital interventions to increase engagement and persuasiveness Visual appearance is equally as important as the content
40 Upcoming digital interventions Portal for STI test results (instead of texts) Online Partner Notification Portal for medication management for HIV+ Online booking for appointments (piloted) Telephone-consultations for stable herpes patients (piloted) Video-consultations for stable HIV patients (and asymptomatic) Chlamydia treatment via post Vending machines with HIV tests in key spots Access to online pharmacies and medication (self-help) Personalised care Highly-targeted Health Promotion
41 Personalised Care The Future of the NHS
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43 Aim: To assess HPV vaccine acceptability in MSM Needed to recruit: - Sample size: 800 gay/bisexual men (power) - Below the age of 26 (vaccine licenced <26) - From small/medium towns across the UK - At the beginning of sexual activity (HPV exposure)
44 Men recruited during Brighton Pride 1200 leaflets handed out ~100 boys kissed as incentive
45 Outcome: - 16 completed surveys - Only 9 were below the age of 26 - Spend 115 on printing (plus my time) - A massive hangover
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54 30 studies using Facebook for recruitment In 12 studies FB was most effective methods In 5 studies FB was the most cost-effective method Hard-to-Reach populations & specific conditions
55 Conclusion: * Digital revolution is unstoppable * Need for harnessing digital technologies for healthcare * Emerging evidence for effectiveness against STIs * Upcoming forms of E-Health and M-Health * Personalised care for the biggest impact
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57 Upcoming event: The launch of Digital Sexual Health Hub Date: May (TBC) Location: University of Southampton, Highfield Duration: 2.5h (refreshments included) Aim: To strengthen networking and collaboration on research projects within sexual health
58 Thank you Tom Nadarzynski
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