London School of Hygiene & Tropical Medicine

Improving sexual health in young people via low-cost mobile phone messaging campaigns is being be investigated in a new trial led by the London School of Hygiene & Tropical Medicine.

The Safetxt trial, funded by a £1.4 million grant from the National Institute of Health Research (NIHR), is designed to reduce sexually transmitted infections (STIs) in young people in England by sending regular text messages offering non-judgemental sexual health support. The messages, developed after a pilot trial and consultation with young people, will support recipients in telling a partner about an infection, using condoms, and getting tested before unprotected sex with a new partner.

Younger people have the highest rates of STIs such as chlamydia and gonorrhoea, which can have severe long-term health effects including ectopic pregnancy and fertility problems. In the UK, the estimated direct cost of treating chlamydia and gonorrhoea in 2004 was £70 million, while the overall cost of treating STIs and resulting conditions in 2003 was £700 million.

Safer sex support delivered by text message is inexpensive, and is a method generally well received by young people. The pilot trial was successful, with recipients reporting in interviews that the messages helped them in telling partners about an infection and in negotiating condom use.

The new four-year randomised controlled trial will recruit 5,000 people aged 16-24 who have been diagnosed with gonorrhoea, chlamydia, or another type of urethritis (inflammation of the urethra) in the previous two weeks at sexual health services across England. Participants will be randomly allocated either to a group who will receive regular sexual health support text messages, or to a control group who will be sent one monthly text simply asking them to update their contact details.

Using postal STI tests, the research team will measure the effect of the messaging campaign on chlamydia and gonorrhoea infections among participants after one year. Secondary outcomes of telling a partner about an infection, condom use and STI testing will be assessed by data from self-reported questionnaires after one month and again after one year. Data from all trial participants will reveal whether those receiving the regular text messages have improved sexual health outcomes and increased safer sex behaviours.

Dr Caroline Free, Clinical Associate Professor at the School and Chief Investigator on the trial, said: "Text messaging is a low-cost, non-stigmatising way to provide sexual health advice and support to young people, who may be unaware of a symptomless condition, or who may struggle to tell their sexual partners about an existing STI.

"This funding will allow us to assess whether large-scale mobile phone messaging could help reduce STIs in this age group by increasing awareness and promoting safer sex behaviours."  

The text messages have been written and adapted based on young people's preferences, and are tailored to individuals by gender, sexual orientation and according to the STI diagnosed. The messages offer a range of support and information, including suggestions about when, where, and how to tell partners about an STI, tips on how to avoid problems using condoms, and advice regarding getting tested before unprotected sex with a new partner.

Additionally, the messages contain links to services and support for those concerned about relationship violence or abuse, and links to information about contraception, alcohol and sexual risk, and general communication about sex.

The research involves partners at University College London, University of London and King's College London NHS Foundation Trust. It is funded by the NIHR Public Health Research programme (14/182/07).

The views and opinions expressed in this article are those of the authors and do not necessarily reflect those of the Public Health Research programme, NIHR, NHS or the Department of Health.