Community Self-Sampling for Chlamydia, Gonorrhoea, Syphilis, HIV, Hepatitis B and Hepatitis C in Wales
Public Health Wales
Introduction:
The online Test and Post service launched in May 2020 to meet STI testing needs during COVID-19. Demand quickly exceeded expectations, with over 72,000 kits ordered in the first year. However, inequities became evident: the service excluded people without fixed addresses, internet access, phones, or adequate literacy. In response, Public Health Wales’ Sexual Health Programme launched the community arm of Test and Post in January 2024 to address barriers among inclusion health groups.
Methods:
Generic, self-sampling kits were designed in three types (Vaginal, Penile, Universal), enabling people to test for a full range of STIs. Naming kits by anatomy rather than gender improved accessibility for trans and non-binary individuals. The team collaborated with stakeholders (NHS, third sector, HM Prison and Probation Service, schools, and local authorities) to establish 351+ distribution sites including libraries, probation centres, sports clubs, and prisons. Training was offered to site staff to support distribution without clinical involvement, with ongoing support provided by health advisers.
Outcomes:
- Kits successfully reached populations previously unable to access online services
- Distribution sites continue to expand, with strong uptake and repeat orders
- Kits support broader public health goals (HIV Action Plan, Hepatitis B/C elimination)
- Additional resources (condoms, pregnancy tests, multilingual materials) increase impact
- Clinic pressure reduced, allowing focus on complex cases
- Testing was normalised and made more discreet and accessible
Learnings:
- Flexibility is essential: kit usage and delivery must adapt to each setting
- Partnerships are key to reach marginalised populations
- The service supports people aged 13–16 via trained staff with safeguarding protocols
- The approach builds trust and removes barriers to testing
What Next?
The service will continue expanding through stakeholder engagement, events, and outreach. Data from community kits will guide refinement and targeting, ensuring ongoing improvement in equitable sexual health access across Wales.
