Who accessed STI testing in Britain during the COVID-19 pandemic and how: Findings from Natsal-COVID, a cross-sectional quasi-representative survey.

Background: During the COVID-19 pandemic, online sexual health service delivery increased across Britain. We investigated inequalities in STI testing access and methods of access during the first year of the pandemic.

Methods: Natsal-COVID, an online-survey of people 18-59 years in Britain, explored sexual health experiences in the first year of the pandemic. We describe the socio-demographics of participants who used STI testing services and compare those who reported being "online service users", defined as using services with no direct clinician interactions (regardless of whether they also used other methods), with those who were exclusively "other service users", defined as face-to-face, telephone, or video calls.

Results: 246/6,064 participants (4.2%) reported STI testing between 03/2020-03/2021. Of those, 35.8% (95%CI 29.2-42.8) used online services. Online service users (compared to other service users) were more often white (74.9% (62.2-84.4) versus 68.5% (59.4-76.3)), less often had anxiety (39.0% (28.4-50.9) versus 57.2% (48.4-65.6)) and less often had disabilities (25.8% (16.8-37.4) versus 48.1% (39.4-56.9)). Among women (only), online users were more often in good health (91.4% (81.3-96.2) versus 69.3% (57.4-79.2)).

Conclusions: More than one third of STI testers used online services during this period. Differences exist in the characteristics of people accessing online versus other testing services. These data suggest that online services were more likely to be accessed by groups with typically lower risk of poor sexual health (white and in good health). Further investigation is needed, especially if online services are the only option offered, as differences in ability to access services could widen inequalities.