INTRODUCTION:Gay, bisexual and other men who have sex with men are disproportionately affected by HIV and other sexually transmitted infections (STIs). This study explores preferences for different models of sexual health services among gay, bisexual and other men who have sex with men in Australia, using discrete choice experiments (DCEs). METHODS:A cross-sectional online survey was conducted from November 2022 to February 2023, targeting three groups: (1) gay, bisexual and other men who have sex with men living with HIV; (2) pre-exposure prophylaxis (PrEP) users; and (3) non-PrEP users. Participants were recruited through paid advertisements, sexual health clinics and community networks. The survey included demographic questions, sexual behaviour inquiries and three tailored DCEs to quantify preferences for service delivery attributes such as cost, type of clinic, appointment type, appointment frequency, extra services and where samples are taken for HIV/STI testing. We used latent class analyses to identify subgroups of people with similar preferences. RESULTS:We recruited 1422 participants. The median age was 41 (interquartile range [IQR]: 32-54) for gay, bisexual and other men who have sex with men living with HIV (N = 396), 35 (IQR: 29-45) for PrEP users (N = 436) and 33 (IQR: 26-44) for non-PrEP users (N = 590). In our latent class analyses, gay, bisexual and other men who have sex with men living with HIV preferred sexual health services to be delivered via sexual health clinics (46.2%), general practitioners (GP) with expertise in lesbian, gay, bisexual, trans, queer and others (LGBTQ+) health (33.0%) or were happy to go anywhere and to pay (20.7%). PrEP users preferred either PrEP-only clinics or GP with expertise in LGBTQ+ health (75.2%) and GP with expertise in LGBTQ+ health only (24.8%). Non-PrEP users preferred GP with expertise in LGBTQ+ health (44.7%) or any free service (22.8%); some did not want to test (22.2%) or were unsure of their preferences (10.2%). CONCLUSIONS:To align service models with client needs, investment in specialist sexual health clinics and LGBTQ+ competent GPs is important, though this may depend on local resources and infrastructure. Future research should focus on addressing financial barriers, evaluating telehealth and digital health interventions, and understanding testing reluctance among non-PrEP users.

Evaluating HIV preexposure prophylaxis (PrEP) use and HIV risk events concurrently remains challenging. We developed a single question method for measuring prevention-effective adherence with PrEP in self-report questionnaires. In a questionnaire completed by 409 gay and bisexual men, 46% reported condomless anal sex that was not covered by their own PrEP use, and this was more common among younger, lower-income participants. Refining this questionnaire item could improve measurement of prevention-effective adherence.

BackgroundSexually transmitted infection (STI) rates continue to rise in Australia, and timely access to testing and treatment is crucial to reduce transmission. Web-based services have been viewed as a way to improve timely access to STI/HIV testing and have proliferated in recent years. However, the regulation of these services in Australia is minimal, leading to concerns about their quality. The purpose of this review was to systematically identify web-based STI/HIV testing services available in Australia and assess them on aspects of quality, reliability, and accessibility. ObjectiveWe aim to systematically identify and assess web-based STI/HIV testing services available in Australia. MethodsA Google search of Australian web-based services was conducted in March 2022 and repeated in September 2022 using Boolean operators and search terms related to test services (eg, on the internet or home), STIs (eg, chlamydia or gonorrhea), and test type (eg, self-test). The first 10 pages were assessed, and services were categorized as self-testing (ST; test at home), self-sampling (SS; sample at home and return to laboratory), or self-navigated pathology (SNP; specimens collected at pathology center). Website reliability was assessed against the Health on the Net Foundation code of conduct, and service quality was assessed using a scorecard that was developed based on similar reviews, Australian guidelines for in-person services, and UK standards. Additionally, we looked at measures of accessibility including cost, rural access, and time to test results. ResultsSeventeen services were identified (8 ST, 2 SS, and 7 SNP). Only 4 services offered recommended testing for all 4 infections (chlamydia, gonorrhea, syphilis, and HIV) including genital, anorectal, and oropharyngeal sites, and 5 offered tests other than those recommended by Australian testing guidelines (eg, Ureaplasma). Nine services (1 SNP, 8 self-test) had no minimum age requirements for access. Reliability scores (scale 0-8) were similar between all services (range 4.75-8.0). Quality weighted scores (scale 0-58) were similar between SNP and SS services (average 44.89, SD 5.56 and 44.75, SD 1.77, respectively) but lower for ST services (22.66, SD 8.93; P=.002). Government-funded services were of higher quality than private services (43.54, SD 6.71 vs 29.43, SD 13.55; P=.03). The cost for services varied between SNP (Aus $0-$595; ie, US $0-$381.96), self-sample (Aus $0; ie, US $0), and ST (Aus $0-$135; ie, US $0-$86.66). The time to test results was much shorter for SNP services (~4 days) than for SS (~12 days) and ST (~14 days). ConclusionsThis review identified considerable variability in the quality and reliability of the web-based STI/HIV testing services in Australia. Given the proliferation and use of these services will likely increase, it is imperative that Australia develops national standards to ensure the standard-of-care offered by web-based STI/HIV testing services is appropriate to protect Australian users from the impact of poorly performing and inappropriate tests.

BACKGROUND:In the context of an expanding syphilis epidemic, we assessed the integration of sexually transmissible infection (STI) testing within annual health assessments for Aboriginal and Torres Strait Islander young people aged 16-29years in Aboriginal Community Controlled Health Services between 2018 and 2020.METHODS:Using routinely collected electronic medical record data from a national sentinel surveillance system (ATLAS), we performed a cross-sectional analysis to calculate the proportion of assessments that integrated any or all of the tests for chlamydia, gonorrhoea, syphilis, and HIV. We used logistic regression to identify correlates of integration of any STI test.RESULTS:Of the 13 892 assessments, 23.8% (95% CI 23.1, 24.6) integrated a test for any STI and 11.5% (95% CI 10.9, 12.0) included all four STIs. Of assessments that included a chlamydia/gonorrhoea test, 66.9% concurrently included a syphilis test. Integration of any STI test was associated with patients aged 20-24years (OR 1.2, 95% CI 1.1-1.4) and 25-29years (OR 1.1, 95% CI 1.0-1.2) compared to 16-19years and patients residing in very remote (OR 4.2, 95% CI 3.7-4.8), remote (OR 2.4, 95% CI 2.1-2.8), and regional areas (OR 2.5, 95% CI 2.2-2.8) compared to metropolitan areas. There was no association with patient sex.CONCLUSIONS:Integration of STI testing into annual health assessments for Aboriginal and Torres Strait Islander young people was higher in remote areas where disease burden is greatest. Integration is similar in men and women, which contrasts with most studies that have found higher testing in women.

OBJECTIVES:To examine changes in the positive infectious syphilis test rate among women and heterosexual men in major Australian cities, and rate differences by social, biomedical, and behavioural determinants of health.DESIGN, SETTING:Analysis of data extracted from de-identified patient records from 34 sexual health clinics participating in the Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of Sexually Transmissible Infections and Blood Borne Viruses (ACCESS).PARTICIPANTS:First tests during calendar year for women and heterosexual men aged 15 years or more in major cities who attended ACCESS sexual health clinics during 2011-2019.MAIN OUTCOME MEASURES:Positive infectious syphilis test rate; change in annual positive test rate.RESULTS:180 of 52 221 tested women (0.34%) and 239 of 36 341 heterosexual men (0.66%) were diagnosed with infectious syphilis. The positive test rate for women was 1.8 (95% confidence interval [CI], 0.9-3.2) per 1000 tests in 2011, 3.0 (95% CI, 2.0-4.2) per 1000 tests in 2019 (change per year: rate ratio [RR], 1.12; 95% CI, 1.01-1.25); for heterosexual men it was 6.1 (95% CI, 3.8-9.2) per 1000 tests in 2011 and 7.6 (95% CI, 5.6-10) per 1000 tests in 2019 (RR, 1.10; 95% CI, 1.03-1.17). In multivariable analyses, the positive test rate was higher for women (adjusted RR [aRR], 1.85; 95% CI, 1.34-2.55) and heterosexual men (aRR, 2.39; 95% CI, 1.53-3.74) in areas of greatest socio-economic disadvantage than for those in areas of least socio-economic disadvantage. It was also higher for Indigenous women (aRR, 2.39; 95% CI, 1.22-4.70) and for women who reported recent injection drug use (aRR, 4.87; 95% CI, 2.18-10.9) than for other women; it was lower for bisexual than heterosexual women (aRR, 0.48; 95% CI, 0.29-0.81) and for women who reported recent sex work (aRR, 0.35; 95% CI, 0.29-0.44). The positive test rate was higher for heterosexual men aged 40-49 years (aRR, 2.11; 95% CI, 1.42-3.12) or more than 50 years (aRR, 2.36; 95% CI, 1.53-3.65) than for those aged 15-29 years.CONCLUSION:The positive test rate among both urban women and heterosexual men tested was higher in 2019 than in 2011. People who attend reproductive health or alcohol and drug services should be routinely screened for syphilis.

Background: In the context of a syphilis outbreak in neighboring states, a multifaceted systems change to increase testing for sexually transmitted infections (STIs) among young Aboriginal people aged 15 to 29 years was implemented at an Aboriginal Community Controlled Health Service (ACCHS) in New South Wales, Australia. The components included electronic medical record prompts and automated pathology test sets to increase STI testing in annual routine health assessments, the credentialing of nurses and Aboriginal health practitioners to conduct STI tests independently, pathology request forms presigned by a physician, and improved data reporting.Objective: We aimed to determine whether the systems change increased the integration of STI testing into routine health assessments by clinicians between April 2019 and March 2020, the inclusion of syphilis tests in STI testing, and STI testing uptake overall. We also explored the understandings of factors contributing to the acceptability and normalization of the systems change among staff.Methods: We used a mixed methods design to evaluate the effectiveness and acceptability of the systems change implemented in 2019. We calculated the annual proportion of health assessments that included tests for chlamydia, gonorrhea, and syphilis, as well as an internal control (blood glucose level). We conducted an interrupted time series analysis of quarterly proportions 24 months before and 12 months after the systems change and in-depth semistructured interviews with ACCHS staff using normalization process theory.Results: Among 2461 patients, the annual proportion of health assessments that included any STI test increased from 16% (38/237) in the first year of the study period to 42.9% (94/219) after the implementation of the systems change. There was an immediate and large increase when the systems change occurred (coefficient=0.22; P=.003) with no decline for 12 months thereafter. The increase was greater for male individuals, with no change for the internal control. Qualitative data indicated that nurse-and Aboriginal health practitioner-led testing and presigned pathology forms proved more difficult to normalize than electronic prompts and shortcuts. The interviews identified that staff understood the modifications to have encouraged cultural change around the role of sexual health care in routine practice.Conclusions: This study provides evidence for the first time that optimizing health assessments electronically is an effective and acceptable strategy to increase and sustain clinician integration and the completeness of STI testing among young Aboriginal people attending an ACCHS. Future strategies should focus on increasing the uptake of health assessments and promote whole-of-service engagement and accountability.

The 'Australian Sexually Transmitted Infection (STI) Management Guidelines For Use In Primary Care' (www.sti.guidelines.org.au ) provide evidence-based, up-to-date guidance targeted at use in primary care settings. A major review of the guidelines was undertaken in 2020-22. All content was reviewed and updated by a multi-disciplinary group of clinical and non-clinical experts, and assessed for appropriateness of recommendations for key affected populations and organisational and jurisdictional suitability. The guidelines are divided into six main sections: (1) standard asymptomatic check-up; (2) sexual history; (3) contact tracing; (4) STIs and infections associated with sex; (5) STI syndromes; and (6) populations and situations. This paper highlights important aspects of the guidelines and provides the rationale for significant changes made during this major review process.

OBJECTIVES:Patient-delivered partner therapy (PDPT) describes the giving of a prescription or antibiotics by an index case with chlamydia to their sexual partners. PDPT has been associated with higher numbers of partners receiving treatment. In Australia, general practitioners (GPs) previously expressed negative views about PDPT. Health authority guidance for PDPT has since been provided in some areas. We investigated recent use and perceptions of PDPT for chlamydia among GPs in Australia.METHODS:In 2019, we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs' chlamydia management practices, including PDPT. Logistic regression identified factors associated with ever offering PDPT. A directed content analysis of free-text data explored GPs' perceptions towards PDPT.RESULTS:The survey received responses from 323 GPs; 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT, while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted OR (AOR) 2.9, 95% CI 1.4 to 5.8), worked in non-metropolitan areas (AOR 2.5, 95% CI 1.5 to 4.4) and jurisdictions with health authority PDPT guidance (AOR 2.3, 95% CI 1.4 to 3.9). Qualitative data demonstrated that many GPs recognised PDPT's potential to treat harder to engage partners but expressed hesitancy to offer PDPT because they considered partners attending for care as best practice. GPs emphasised a case-by-case approach that considered patient and partner circumstances to determine PDPT suitability. To alleviate medicolegal concerns, many GPs indicated a need for professional and health authority guidance that PDPT is permissible. They also desired practical resources to support its use.CONCLUSION:GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment. Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.

BACKGROUND:The sexual and reproductive health care of people with HIV and those at risk of HIV has largely been delivered face-to-face in Australia. These services adapted to the coronavirus disease 2019 (COVID-19) pandemic with a commitment to continued care despite major impacts on existing models and processes. Limited attention has been paid to understanding the perspectives of the sexual and reproductive health care workforce in the research on COVID-19 adaptations.METHODS:Semi-structured interviews were conducted between June and September 2021 with 15 key informants representing a diverse range of service settings and professional roles in the Australian sexual and reproductive health sector. Inductive themes were generated through a process of reflexive thematic analysis, informed by our deductive interest in clinical adaptations.RESULTS:The major adaptations were: triage (rapidly adapting service models to protect the most essential forms of care); teamwork (working together to overcome ongoing threats to service quality and staff wellbeing), and the intwined themes of telehealth and trust (remaining connected to marginalised communities through remote care). Despite impacts on care models and client relationships, there were sustained benefits from the scaleup of remote care, and attention to service safety, teamwork and communication.CONCLUSIONS:Attending to the experiences of those who worked at the frontline of the COVID-19 response provides essential insights to inform sustained, meaningful system reform over time. The coming years will provide important evidence of longer-term impacts of COVID-19 interruptions on both the users and providers of sexual and reproductive health services.

Specialised sexual health clinics (SHCs) play an important role in addressing the staggering rates of STIs seen in many high-income nations. Despite increasing healthcare coverage in the US and nationalised health care in some countries, there is a continued need for SHCs to meet the needs of patients and the community, especially for high-priority populations: those at high risk of STI acquisition and/or groups historically marginalised and underserved in the traditional healthcare system. We need to mobilise resources to support a stronger clinical infrastructure in specialised SHCs. This review describes the importance of SHCs, their future role, and some of the innovative programs housed within SHCs in the US, Australia, and the Netherlands to address both STI and HIV prevention for the populations they serve.

OBJECTIVES:This paper examines factors that enabled successful integration of testing for sexually transmissible infections into routine care in Aboriginal Community Controlled Health Services.METHODS:This paper reports analysis of qualitative interview data recorded with 19 purposively sampled key informants in New South Wales, Australia, representing six Aboriginal Community Controlled Health Services and five government health bodies supporting those services. The analysis explicitly adopted a strengths-based approach.RESULTS:Participants reported a strong belief that routine screening overcomes shame and increases engagement with sexual health screening. Incorporating sexual health screening into general medical consultations increases the capture of asymptomatic cases. The Medicare Benefits Schedule 715 Adult Health Check was highlighted as an ideal lever for effective integration into routine care.CONCLUSION:Integration of testing for sexually transmissible infections into routine care is widely perceived as best practice by senior stakeholders in Aboriginal healthcare in NSW. Findings support continued work to optimise the MBS 715 as a lever to increase testing.IMPLICATIONS FOR PUBLIC HEALTH:Identifying accessible strategies to increase testing for sexually transmissible infections in Aboriginal Community Controlled Health Services can reduce disparities in notifications affecting Aboriginal young people.

BACKGROUND Chlamydia is the most commonly diagnosed bacterial sexually transmissible infection (STI) in Australia. Partner management is key to reducing transmission and a cornerstone of best practice chlamydia management. While most patients will opt for telling their partner(s) themselves, patient-delivered partner therapy (PDPT) offers an alternative way to inform and treat partners where usual management is inappropriate or unlikely to be undertaken. Guidelines for PDPT vary across Australia. Recent research found that general practitioners (GP)s want practical guidance for using PDPT in appropriate situations. OBJECTIVE The aim of this article is to provide an overview of the process of offering PDPT and note the challenges GPs may face in its provision. DISCUSSION PDPT is one option for partner management when sexual partner(s) are unlikely or unable to seek timely care themselves. However, there are challenges to the use of PDPT in general practice. The provision of clear guidelines is an essential step to promote its appropriate use.

Background Patient delivered partner therapy (PDPT) refers to the process in which antibiotic treatment for chlamydia infection is prescribed or provided to an index case to pass onto their sexual partner/s. Since 2015, health authority guidance for PDPT has been provided in some areas of Australia. However evidence regarding PDPT use in Australia are limited. We investigated recent use and perceptions of PDPT for chlamydia among general practitioners (GPs) working in Australia. Methods During 2019 we conducted an online survey comprising multiple-choice and open-ended questions to investigate GPs’ chlamydia management practices, including PDPT. We conducted logistic regression to identify factors associated with offering PDPT and directed content analysis of free-text data to explore GPs’ perceptions towards PDPT. Results A total of 323 GPs responded to the survey, 85.8% (n=277) answered PDPT-focused questions, providing 628 free-text comments. Over half (53.4%) reported never offering PDPT while 36.5% sometimes and 10.1% often offered PDPT. GPs more likely to offer PDPT were aged ≥55 years (adjusted odds ratio, AOR 2.8, 95%CI 1.4–5.7), worked in non-metropolitan areas (AOR 2.5, 95%CI 1.5–4.4) and in Australian States/Territories with health authority PDPT guidance (AOR 2.3, 95%CI 1.4–3.9). Qualitative data showed many GPs recognised PDPT’s potential to treat difficult to engage partners but expressed hesitancy to offer PDPT because they considered it best practice for partners to attend care. A case-by-case approach that considered patient and partner circumstances to determine PDPT suitability was emphasised. Many GPs indicated a need for professional and health authority guidance that PDPT is permissible and practical resources to support its use. Conclusions GPs appear to accept the place of PDPT as targeted to those who may otherwise not access testing or treatment Availability of health authority guidance appears to have supported some GPs to incorporate PDPT into their practice.

Background The 'Down to Test (DTT)' campaign is a sexually transmissible infection (STI) social marketing intervention delivered through outdoor music festival activations and supported by digital media communications in New South Wales, Australia. This paper investigates whether and how the tailored messages reached the intended audience. Methods Data was collected through three annual rounds of online surveys post campaign exposure, targeting young people (aged 15-29years) attending 14 music festivals in NSW from October 2017 to March 2020. Descriptive statistics, principal component analysis and multivariable logic regression were applied to identify the key client segment and factors associated with a strong intention for future STI screening. Results Of the 10044 participants with a valid urine specimen submitted, 261 (2.8%) tested positive for chlamydia. Altogether, 1776 participants (median age=22) self-completed the evaluation surveys online with more being female (73.4%) than male (26.2%). Participants were mostly Australian-born (89.5%), heterosexual (82.6%) and the majority being sexually active (96.7%). Rates of self-reported lifetime STI testing (70.4%) and intention for future STI screening ('definitely yes' in the next 12months, 39.0%) were also high. The most significant factor associated with future intention for STI testing is the Sexual Experience and Perception Factor (adjusted odds ratio [AOR]=2.02; 95%CI 1.76-2.32; P<0.001), followed by the Sexual Beliefs and Attitudes Factor (AOR=1.14; 95% CI 1.01-1.30; P<0.05). Conclusions The NSW state-wide DTT campaign has largely reached sexually active youth who are attentive to sexual health promotion messages and contributed to enhanced STI screening in a fun and peer-supportive environment.

There is a paucity of contemporary data pertaining to sexually transmitted infection test positivity of people presenting as contacts of syphilis. Over a 12 month period in 2018, within a sexual health service, we identified 191 (92% men who have sex with men) presentations, 7.8% were diagnosed with syphilis (three primary, four secondary, six early latent and two late latent infections). A total of 20.8% (38/183) were diagnosed with one or more STI including 54 non-syphilis infections: two (1.1%) new HIV; 26 (14.2%) Chlamydia trachomatis; and 24 (13.1%) Neisseria gonorrhoeae. Although syphilis test positivity in contacts is low, this population requires comprehensive STI screening and HIV prevention discussion.

Background In Australia, infectious syphilis notifications have increased 234% in the past decade, from 1318 in 2008 to 4398 in 2017. Although historically concentrated among urban men who have sex with men and remote Indigenous communities, a rise in syphilis notifications among women in major cities and cases of congenital syphilis have been observed. We analysed trends in infectious syphilis positivity among women and heterosexual men in major Australian cities and identified associated risk factors. Methods De-identified patient data were extracted from 34 sexual health clinics within a national sentinel surveillance network (2011–18). All women and heterosexual men ≥ 15 years in major cities were included. Infectious syphilis positivity was defined as the proportion of attendees per 6-monthly calendar period with recorded syphilis testing who had recorded clinical diagnoses of infectious syphilis. Poisson regression determined annual trends in positivity and risk factors for infectious syphilis (rate ratios and 95% CIs). Results Of 100,230 patients attending the clinics, 50.8% were female (of whom, 96.1% were of childbearing age), 51.2% were aged 15–29 years, 1.7% were Indigenous and 7.4% were from culturally and linguistically diverse (CALD) backgrounds. Modelled positivity for infectious syphilis (2011–18) increased 85% in females from 2.41 (95%CI:1.67–3.14) to 4.48 (95%CI:3.53–5.43) per 1000 patients tested, and 76% in heterosexual males from 4.47 (95%CI:3.44–5.49) to 7.87 (95%CI:6.49–9.24). Factors associated with increased risk of infectious syphilis included: reporting a history of injecting drug use (RR:4.36;95%CI:3.26–5.83), using condoms inconsistently in the past year (RR:2.30;95%CI;1.10–4.79), being male (RR:1.80;95%CI:1.51–2.14), Indigenous (RR:1.70;95%CI:1.02–2.84), from CALD backgrounds (RR:1.90;95%CI:1.46–2.46), and older (30–39 years: RR:1.33;95%CI:1.08–1.65; 40–49 years: RR:2.95;95%CI:2.34–3.73; 50+ years:RR:3.59;95%CI:2.81–4.57). Lower risk was observed in bisexual females (RR:0.53;95%CI:0.30–0.94) and female sex workers (RR:0.43;95%CI:0.29–0.63). Conclusion Increasing syphilis in women and heterosexual men in major Australian cities requires enhanced prevention, including integration of sexual and reproductive health care into harm reduction programs.

Mycoplasma genitalium ( M.genitalium) is associated with urethritis, cervicitis, pelvic inflammatory disease, proctitis and epididymitis. Its treatment is complicated by antimicrobial resistance. To assess clinicians’ adherence to M.genitalium diagnostic testing recommendations for syndromic presentations, as well as resistance-guided management of M.genitalium at Sydney Sexual Health Centre, we reviewed patients presenting between August and December 2018. 349/372 (94%) syndromic presentations were tested for M.genitalium with 16% M.genitalium test positivity and 81% macrolide resistance. 16/27 (59%) macrolide-sensitive infections and 65/77 (84%) macrolide-resistant infections received resistance-guided treatment. Tests of cure (TOCs) were unnecessarily ordered for 82% macrolide-sensitive cases, while 88% macrolide-resistant cases were correctly ordered TOCs. Co-existing STIs at the time of macrolide-sensitive ( p = 0.30) or macrolide-resistant M.genitalium ( p = 0.94) diagnosis did not significantly affect adherence to treatment guidelines. This study confirms the expected prevalence of M.genitalium and macrolide resistance in syndromic presentations while our real-world data highlight the decision-making challenges involved with managing M.genitalium, offering insights for further research.

Objective: Examine the changes in service delivery Australian public sexual health clinics made to remain open during lockdown. Methods: A cross-sectional survey designed and delivered on Qualtrics was emailed to 21 directors of public sexual health clinics across Australia from July-August 2020 and asked about a variety of changes to service delivery. Descriptive statistics were calculated. Results: Twenty clinics participated, all remained open and reported service changes, including suspension of walk-in services in eight clinics. Some clinics stopped offering asymptomatic screening for varying patient populations. Most clinics transitioned to a mix of telehealth and face-to-face consultations. Nineteen clinics reported delays in testing and 13 reported limitations in testing. Most clinics changed to phone consultations for HIV medication refills (n=15) and eleven clinics prescribed longer repeat prescriptions. Fourteen clinics had staff redeployed to assist the COVID-19 response. Conclusion: Public sexual health clinics pivoted service delivery to reduce risk of COVID-19 transmission in clinical settings, managed staffing reductions and delays in molecular testing, and maintained a focus on urgent and symptomatic STI presentations and those at higher risk of HIV/STI acquisition. Implications for public health: Further research is warranted to understand what impact reduced asymptomatic screening may have had on community STI transmission.