IMPROVING CARE FOR PEOPLE WITH SEXUALLY TRANSMITTED INFECTIONS (STIs) IN A DIGITAL NHS.

≪p≫Background: Multiple factors challenge the control of Sexually Transmitted Infections (STIs), including rises in key STIs, increasing antimicrobial resistance, and large-scale disinvestment in sexual health services with growing unmet need. Online sexual healthcare offers considerable potential for health gains and aligns with NHS digital- and self-managed strategies, but evidence for effectiveness is lacking, particularly related to clinical outcomes, impact on health inequalities, patient experience, and economic parameters. We previously developed an innovative eSexual Health Clinic (eSHC), accessible on mobile phones, and demonstrated safety and feasibility in exploratory studies. It contains a unique-to-the-NHS online automated clinical consultation and electronic prescribing algorithm for comprehensive management of people with chlamydia and their partners via the Online Chlamydia Care Pathway (OCP). It could provide considerable health gains for people with STIs and could be applied across the NHS for many other health conditions, but it now needs full scale evaluation. Overarching aim: To improve health outcomes for people with STIs and their partners, by developing and evaluating inclusive, comprehensive, evidence-based clinical care pathways fit for a digital NHS. This will be achieved through five inter-linking work packages (WPs): WP1 determines patterns of uptake of current online versus physical sexual health services and identifies modifiable factors to increase engagement and reduce health inequalities, using quantitative analysis of existing surveillance, research and service datasets, qualitative interviews with thematic analysis, secondary behavioural analysis, and mixed methods studies (Year 1). WP2 optimises key components of the OCP, focussing on the partner elements, and conducts randomised pilot studies, together with a preliminary cost-consequence analysis, using behaviour change wheel analysis and Human Computer Interaction methods, preliminary cost analyses, and external and internal pilot studies (Years 1-3). WP3 determines the effectiveness of the OCP compared with routine care in a pragmatic individually-randomised RCT, with an integral process evaluation to explore how content and context intersect to shape outcomes, for people with chlamydia and their partners (Years 4-5). WP4 evaluates the equity and efficiency of the OCP through undertaking an economic analysis based on the outcomes of the trial, exploratory distributional cost-effectiveness analysis and exploring the potential impact on health inequalities (Years 4-5). WP5 ensures the research remains responsive to a rapidly changing environment and enables timely translation of findings into health policy and practice, using co-production, using World café methods with analysis using Theoretical Domains Framework and Normalisation Process Theory (Years 1-5). Impact: This programme will improve clinical outcomes, service efficiency and public health practice. The proposed intervention aims to reduce STI transmission, reinfection and complications with individual and population-level impacts. It will provide new insights and outputs to advance the development, uptake and delivery of online clinical care within a digital NHS. PPI: Our Research Voice Advisory Group encouraged us to do this research; one member is a co-applicant. Patients and public and community groups are involved in design, planning, delivery and dissemination. Dissemination: Our multi-format, multi-perspective dissemination strategy, underpinned by three interactive stakeholder workshops to co-produce pathways will enable timely dissemination of programme findings and translation into practice.≪/p≫