CONNECT study

Remote consultations in sexual and reproductive health services: a systematic review of evidence on effectiveness, cost-effectiveness, experiences, access and equity

This article looks at how sexual and reproductive health services (SRHS) have increasingly used “remote consultations”—such as phone calls, video calls, and online systems—especially after COVID‑19 and funding changes, rather than face-to-face appointments. SRHS services include testing and treatment for sexually transmitted infections (STIs), contraception, HIV care and Pre-Exposure Prophylaxis (PrEP, which reduces the risk of getting HIV). Remote care can make services easier to access, but there has been little evidence collected about how well it works or whether it increases inequalities. To understand this better, the authors systematically reviewed 48 studies published since 2011 across the UK and OECD countries.

The review found that remote consultations are often convenient for both patients and providers. Many people liked the flexibility, reduced travel time, and greater privacy when discussing sensitive issues. Clinically, most studies reported that remote care was “about as effective” as in‑person care for certain tasks—such as routine STI follow‑up, contraception counselling, or HIV monitoring. However, the evidence was limited and often of low to medium quality. Many studies also highlighted clear challenges, including poor internet access, limited digital skills, lack of private spaces at home, difficulty building rapport, and the inability to provide physical examination or procedures, such as providing long‑acting contraception.

Overall, the article concludes that while remote consultations can play a valuable role in SRHS, there is still not enough strong evidence about their long‑term impact, cost‑effectiveness, or effects on health inequalities. The authors recommend more high‑quality research and updated national guidelines to help services use remote and in‑person care appropriately and effectively. They emphasise the importance of ensuring remote models do not widen inequalities—particularly for people with limited digital access, those in rural areas, or marginalised groups—and suggest that there should be better support, training, and technology to make remote SRH care fair and effective for everyone.

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What guidance exists to support remote consultations in sexual and reproductive health services? A review of the policy and practice literature

This article explores how remote consultations—such as phone, video, online forms and text-based appointments—are being used in Sexual and Reproductive Health Services (SRHS). The use of remote methods expanded rapidly during COVID‑19, but there is limited information about how they should be delivered safely and fairly. The authors note that SRHS involve sensitive issues such as testing for sexually transmitted infections (STIs), contraception and abortion care, and that some groups (e.g., people with low income, young people, ethnic minorities) already face barriers to accessing care. The review aimed to find out what guidance currently exists to help services implement remote consultations and how well that guidance addresses quality, safety and equity.

To do this, the research team searched widely for grey literature—which means documents such as guidelines, reports, organisational statements, blogs and toolkits—from 2018 to 2024. They used Google searches, the Health Management Information Consortium database (HMIC) and the websites of professional organisations like the British Association for Sexual Health and HIV (BASHH), the British HIV Association (BHIVA) and the College of Sexual and Reproductive Healthcare (now CoSRH, formerly Faculty of Sexual and Reproductive Healthcare – FSRH). The searches found that although many organisations do support remote consultations, there is very little detailed or evidence‑based guidance specifically for SRHS. Some documents highlight good practice—such as performing safeguarding checks, offering in‑person appointments when needed, and providing clear information to service users—but many recommendations rely on limited evidence. Most guidance mentions potential equity benefits (e.g., easier access for people in rural areas or for those with disabilities), yet also acknowledges risks such as poor internet access, lack of privacy at home, low digital skills and reduced ability to identify safety concerns remotely.

Overall, the review concludes that current guidance is fragmented and incomplete, leaving services without clear direction on when remote care is appropriate and how to protect vulnerable groups. The authors recommend developing more robust, evidence‑informed national guidance, including clearer criteria for when to switch between remote and in‑person appointments, stronger safeguarding protocols, and improved digital support for disadvantaged groups. They also emphasise the need to involve service users in designing remote services and to consider equity and intersectionality more explicitly in future policies. More research is therefore needed to determine the best ways to integrate remote and in‑person SRHS in a fair, safe and effective way.

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