Do Australian sexual health clinics have the capacity to meet demand? A mixed methods survey of directors of sexual health clinics in Australia.

The majority of directors of publicly funded sexual health clinics in Australia responded to the survey.

• 27 of 35 directors of sexual health clinics responded to the survey.
• The survey was conducted between January and March 2024.
• The survey asked about how clinics were managing current clinical demand.
• Response rate was approximately 77%.

Sexual health clinics offered a limited number of daily bookings and very few walk-in consultations.

• Clinics offered a median of 35 (IQR: 20-60) bookings each day.
• Only a median of 10 (IQR: 2-15) walk-in consultations were available for symptomatic patients.
• The low number of walk-in slots relative to total bookings suggests most capacity is pre-allocated.
• Walk-in access for symptomatic patients was notably constrained compared to total clinic capacity.

Clinics were unable to see all symptomatic patients on a substantial proportion of days, particularly during summer.

• The average proportion of days that clinics were able to see all symptomatic patients was 70.1% (95% CI 55.4, 84.9) during summer.
• During winter, clinics could see all symptomatic patients on 75.4% (95% CI 62.2, 88.5) of days.
• This means clinics failed to accommodate all symptomatic patients on approximately 30% of summer days and 25% of winter days.
• When adjusted for the number of consultations provided, the proportion of symptomatic individuals seen fell to 51.0% in summer and 65.2% in winter.

Clinics were even less able to meet demand from asymptomatic patients seeking STI screening.

• Clinics could see all asymptomatic patients on only 53.3% (95% CI 37.9, 68.8) of summer days.
• During winter, the proportion was 57.7% (95% CI 41.7, 73.7) for asymptomatic patients.
• After adjustment for consultation numbers, corresponding figures were 48.1% for summer and 49.8% for winter.
• Asymptomatic patients had lower rates of full accommodation than symptomatic patients in both seasons.

There was extreme variation in clinic catchment populations relative to the number of consultations provided.

• The catchment population per consultation provided ranged from as low as 3,696 to a maximum of 5 million.
• The median catchment population per consultation was 521,077.
• This wide variation suggests highly unequal access to sexual health clinic services across Australia.
• Some clinics serve vastly larger populations per consultation than others, indicating geographic disparities in capacity.

The inability of sexual health clinics to meet demand is likely to delay STI testing and treatment and impede STI control.

• The authors conclude that 'the high proportion of days on which sexual health clinics were not able to see all patients is likely to delay testing and treatment of individuals at high risk of STIs.'
• Capacity gaps were identified for both symptomatic and asymptomatic patient groups.
• The authors note this inadequate capacity could 'impede effective STI control.'
• Both summer and winter data showed consistent shortfalls in capacity to meet demand.