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Walter SR, Jackson J, Myring G, Redaniel MT, Margelyte R, Gardiner R, Clarke MD, Crofts M, McLeod H, Hollingworth W, Phillips D, Muir P, Steer J, Turner J, Horner PJ, De Vocht F. Impact of rapid near-patient STI testing on service delivery outcomes in an integrated sexual health service in the United Kingdom: a controlled interrupted time series study. BMJ Open 2023; 13:e064664. [PMID: 36631238 PMCID: PMC9835959 DOI: 10.1136/bmjopen-2022-064664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES To evaluate the impact of a new clinic-based rapid sexually transmitted infection testing, diagnosis and treatment service on healthcare delivery and resource needs in an integrated sexual health service. DESIGN Controlled interrupted time series study. SETTING Two integrated sexual health services (SHS) in UK: Unity Sexual Health in Bristol, UK (intervention site) and Croydon Sexual Health in London (control site). PARTICIPANTS Electronic patient records for all 58 418 attendances during the period 1 year before and 1 year after the intervention. INTERVENTION Introduction of an in-clinic rapid testing system for gonorrhoea and chlamydia in combination with revised treatment pathways. OUTCOME MEASURES Time-to-test notification, staff capacity, cost per episode of care and overall service costs. We also assessed rates of gonorrhoea culture swabs, follow-up attendances and examinations. RESULTS Time-to-notification and the rate of gonorrhoea swabs significantly decreased following implementation of the new system. There was no evidence of change in follow-up visits or examination rates for patients seen in clinic related to the new system. Staff capacity in clinics appeared to be maintained across the study period. Overall, the number of episodes per week was unchanged in the intervention site, and the mean cost per episode decreased by 7.5% (95% CI 5.7% to 9.3%). CONCLUSIONS The clear improvement in time-to-notification, while maintaining activity at a lower overall cost, suggests that the implementation of clinic-based testing had the intended impact, which bolsters the case for more widespread rollout in sexual health services.
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Affiliation(s)
- Scott R Walter
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joni Jackson
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gareth Myring
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Maria Theresa Redaniel
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ruta Margelyte
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Rebecca Gardiner
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Bristol Haematology and Oncology Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael D Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Hugh McLeod
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - William Hollingworth
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Phillips
- Croydon Sexual Health, Croydon University Hospital, Croydon, UK
| | - Peter Muir
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Jonathan Steer
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Jonathan Turner
- Southwest Regional Laboratory, UK Health Security Agency, North Bristol NHS Trust, Bristol, UK
| | - Paddy J Horner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- National Institute for Health and Care Research, Health Protection Research Unit in Behavioural Science and Evaluation (NIHR HPRU), University of Bristol, Bristol, UK
| | - Frank De Vocht
- National Institute for Health and Care Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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Van Gerwen OT, Talluri R, Camino AF, Mena LA, Chamberlain N, Ford EW, Eaton EF, Muzny CA. Human Immunodeficiency Virus/Sexually Transmitted Infection Testing Preferences for Young Black Men Who Have Sex With Men in the Southeastern United States: Implications for a Post-COVID-19 Era. Sex Transm Dis 2022; 49:208-215. [PMID: 34535613 PMCID: PMC8821133 DOI: 10.1097/olq.0000000000001559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Little is known regarding human immunodeficiency virus (HIV)/sexually transmitted infection (STI) testing preferences for location, staffing, and hours of operation among Young Black men who have sex with men (YBMSM) in the Southeastern United States, a population at high risk for HIV/STIs. We used a discrete choice experiment to explore these preferences. METHODS Young Black men who have sex with men ages 16 to 35 years in Birmingham, AL and Jackson, MS completed online surveys evaluating their preferences (best/worst) for HIV/STI testing locations, staffing, hours, method of results notification, and cost. They also selected preferred combinations of these variables through choice tasks. Results were analyzed using joint best/worst and discrete choice experiment models. RESULTS Between June 2018 and December 2019, participants in Alabama (n = 54) and Mississippi (n = 159) completed online surveys. Both groups preferred stationary testing locations over mobile testing vans, with the most significant difference favoring STI testing-only clinics in Mississippi and local health departments in Alabama (P < 0.001). Technician-performed tests or self-testing were significantly less preferred compared with clinician-performed testing for both groups (P < 0.0001 and P < 0.0001, respectively). Free testing and phone results notification (versus text) were preferred by both groups. The most desirable combination among all participants was weekday clinician-performed testing at the health department for $5. CONCLUSIONS Young Black men who have sex with men in the Southeastern United States prefer traditional testing locations staffed by experienced personnel. Combination choices are influenced by services that are low or no cost. More research is needed to inform the best way(s) to provide affordable, high-quality HIV/STI testing services for YBMSM, particularly in the post-COVID-19 era when sexual health care delivery models are evolving toward home-based and remote health-focused strategies.
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Affiliation(s)
- Olivia T. Van Gerwen
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rajesh Talluri
- Center for Biostatistics and Bioinformatics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Andres F. Camino
- University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Leandro A. Mena
- Department of Population Health Science, University of Mississippi Medical Center, Jackson, MS, USA
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Nicholas Chamberlain
- Division of Infectious Diseases, University of Mississippi Medical Center, Jackson, MS, USA
| | - Eric W. Ford
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ellen F. Eaton
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Christina A. Muzny
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, AL, USA
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Lorenc A, Brangan E, Kesten JM, Horner PJ, Clarke M, Crofts M, Steer J, Turner J, Muir P, Horwood J. What can be learnt from a qualitative evaluation of implementing a rapid sexual health testing, diagnosis and treatment service? BMJ Open 2021; 11:e050109. [PMID: 34686552 PMCID: PMC8543645 DOI: 10.1136/bmjopen-2021-050109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To investigate experiences of implementing a new rapid sexual health testing, diagnosis and treatment service. DESIGN A theory-based qualitative evaluation with a focused ethnographic approach using non-participant observations and interviews with patient and clinic staff. Normalisation process theory was used to structure interview questions and thematic analysis. SETTING A sexual health centre in Bristol, UK. PARTICIPANTS 26 patients and 21 staff involved in the rapid sexually transmitted infection (STI) service were interviewed. Purposive sampling was aimed for a range of views and experiences and sociodemographics and STI results for patients, job grades and roles for staff. 40 hours of observations were conducted. RESULTS Implementation of the new service required co-ordinated changes in practice across multiple staff teams. Patients also needed to make changes to how they accessed the service. Multiple small 'pilots' of process changes were necessary to find workable options. For example, the service was introduced in phases beginning with male patients. This responsive operating mode created challenges for delivering comprehensive training and communication in advance to all staff. However, staff worked together to adjust and improve the new service, and morale was buoyed through observing positive impacts on patient care. Patients valued faster results and avoiding unnecessary treatment. Patients reported that they were willing to drop-off self-samples and return for a follow-up appointment, enabling infection-specific treatment in accordance with test results, thus improving antimicrobial stewardship. CONCLUSIONS The new service was acceptable to staff and patients. Implementation of service changes to improve access and delivery of care in the context of stretched resources can pose challenges for staff at all levels. Early evaluation of pilots of process changes played an important role in the success of the service by rapidly feeding back issues for adjustment. Visibility to staff of positive impacts on patient care is important in maintaining morale.
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Affiliation(s)
- Ava Lorenc
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
| | - Emer Brangan
- Department of Nursing and Midwifery, University of the West of England, Bristol, UK
| | - Joanna M Kesten
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Paddy J Horner
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Michael Clarke
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Megan Crofts
- Unity Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jonathan Steer
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jonathan Turner
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Peter Muir
- South West Regional Laboratory, National Infection Service, Public Health England, Bristol, UK
| | - Jeremy Horwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University of Bristol, Bristol, UK
- NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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4
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Ong JJ, Fairley CK, Hocking JS, Turner KME, Booton R, Tse D, Wong WWCW. Preferences for chlamydia testing and management in Hong Kong: a discrete choice experiment. Sex Transm Infect 2021; 98:408-413. [PMID: 34535577 DOI: 10.1136/sextrans-2021-055182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/05/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES As most chlamydia cases are asymptomatic, regular testing and timely management may be necessary for control. We aimed to determine the preferences of people living in Hong Kong for chlamydia testing and management services. METHODS An online panel of sexually active individuals living in Hong Kong completed the survey with two discrete choice experiments (DCEs). The first DCE examined the preferred attributes of a chlamydia testing service (cost, location, appointment time, speed of results, delivery of results and availability of other STI testing). The second DCE examined the preferred attributes of a chlamydia management service (cost, access to patient-delivered partner therapy, location, travel time, type of person consulted and attitude of staff). RESULTS In total, 520 individuals participated: average age 36.8 years (SD 9.9), 40% males and 66% had a bachelor's degree or higher. Choosing to test was most influenced by cost, followed by speed of results, delivery of results, extra STI testing, appointment available and the least important was the location of testing. Choosing to attend for management was most influenced by staff's attitude, followed by cost, who they consult, access to patient-delivered partner therapy, travel time and the least important was treatment location. CONCLUSION To design effective chlamydia testing and management services, it is vital to respond to patient needs and preferences. For people living in Hong Kong, cost and staff attitude were the most important factors for deciding whether to test or be managed for chlamydia, respectively.
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Affiliation(s)
- Jason J Ong
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia .,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Christopher K Fairley
- Central Cllinical School, Monash University, Melbourne, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Katy M E Turner
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Ross Booton
- School of Social and Community Medicine, Bristol University, Bristol, UK
| | - Desiree Tse
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong
| | - William W C W Wong
- Department of Family Medicine & Primary Care, University of Hong Kong, Hong Kong, Hong Kong.,Department of Family Medicine & Primary Care, The University of Hong Kong-Shenzhen Hospital, Shenzhen, People's Republic of China
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Gan J, Kularadhan V, Chow EPF, Fairley CK, Hocking JS, Kong FYS, Ong JJ. What do young people in high-income countries want from STI testing services? A systematic review. Sex Transm Infect 2021; 97:574-583. [PMID: 34193529 DOI: 10.1136/sextrans-2021-055044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 06/09/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND There are upward trends of STI rates among young people in most high-income countries. We reviewed the literature to provide a summary of information to support health services with the aim of increasing testing of STIs among young people living in high-income countries. METHODS We conducted a systematic review (Prospero: CRD42020179720) using PubMed, Embase, PsychINFO and CINAHL. The search was performed on 10 January 2020 for studies between January 2000 and 10 January 2020. Two reviewers independently screened articles, and any discrepancies were resolved by a third reviewer. Studies were included if they were performed in high-income countries and contained data on both young people (<26 years) and STI testing preferences. Data regarding the characteristics of STI testing services that young people preferred was extracted. We categorised these characteristics using the framework of a social-ecological model. RESULTS We identified 1440 studies, and 63 studies were included in the final review. We found 32 studies that addressed individual factors, 62 studies that addressed service factors and 17 studies that addressed societal factors. At an individual level, we identified eight attributes including the need for improved sexual health education. At a service level, 14 attributes were identified including preferences from different subgroups of young people (such as sexual and ethnic minorities) for the types of services. At a societal level, we identified two attributes including the need to address stigma associated with STIs. CONCLUSION We provide an overview of the growing body of literature capturing the preferences of young people for STI testing services. To optimise the uptake of STI testing among young people, factors from all socioecological levels should be considered. In addition, understanding and accounting for distinct preferences from subgroups of young people could increase demand for STI testing services for those at greatest need.
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Affiliation(s)
- Joscelyn Gan
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Eric P F Chow
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Christopher K Fairley
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Melbourne Sexual Health Centre, Alfred Health, Carlton, Victoria, Australia
| | - Jane S Hocking
- Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - Fabian Y S Kong
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jason J Ong
- Central Clinical School, Monash University, Carlton, Victoria, Australia.,Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK
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6
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Jackson L, Al-Janabi H, Roberts T, Ross J. Exploring young people's preferences for STI screening in the UK: A qualitative study and discrete choice experiment. Soc Sci Med 2021; 279:113945. [PMID: 34010779 DOI: 10.1016/j.socscimed.2021.113945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/16/2021] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Stigma remains a key issue for many health screening interventions such as screening for sexually transmitted infections (STIs). Young people continue to experience the greatest burden of STI infection. In order to increase uptake, screening services need to be more patient-focused. This study sought to examine young people's preferences for sexual health screening to understand how scarce public health resources can optimise screening uptake. METHODS This study involved both qualitative and quantitative components. Focus groups and individual interviews were undertaken with young people aged 16-24 recruited from community settings and a specialist clinic. Themes which emerged from the focus groups were used to inform the design of a discrete choice experiment (DCE). A questionnaire survey (incorporating the DCE) was conducted with members of an internet panel, with over-sampling of black, Asian and minority ethnic groups. RESULTS Overall, 41 participants took part in eight focus groups and two in individual interviews. Six major themes emerged as important when making decisions about STI screening - stigma and embarrassment; knowledge about STIs and risk; where to get tested; how staff would treat them; what STIs to be tested for; and convenience (waiting times). Overall, 1946 participants took part in the survey. The DCE results revealed that the most important factors for young people are that all STIs are tested for, and that staff attitude is non-judgemental. The results also suggest that there is a preference for screening in specialist clinics and for full appointments over limited ones. Although respondents preferred shorter time periods for appointments and results, other 'process' factors were also important. CONCLUSION This study demonstrates that by combining qualitative and quantitative methods, a richer understanding of STI screening preferences is possible. The findings show that comprehensive testing and a perceived 'non-judgemental' attitude are particularly important to young people, as well as convenience.
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Affiliation(s)
- Louise Jackson
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK.
| | - Hareth Al-Janabi
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK
| | - Tracy Roberts
- Health Economics Unit, Institute of Applied Health Research, College of Medical & Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B152TT, UK
| | - Jonthan Ross
- Department of GU Medicine, University Hospitals Birmingham NHS Foundation Trust, Whittall Street Clinic, Whittall Street, Birmingham B4 6DH, UK
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Sharma M, Ong JJ, Celum C, Terris-Prestholt F. Heterogeneity in individual preferences for HIV testing: A systematic literature review of discrete choice experiments. EClinicalMedicine 2020; 29-30:100653. [PMID: 33305199 PMCID: PMC7710637 DOI: 10.1016/j.eclinm.2020.100653] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/25/2020] [Accepted: 11/06/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Understanding variations in HIV testing preferences can help inform optimal combinations of testing services to maximize coverage. We conducted a systematic review of Discrete Choice Experiments (DCEs) eliciting HIV testing preference. METHODS We searched the published literature for papers that conducted DCEs to assess user preferences for HIV testing. FINDINGS We identified 237 publications; 14 studies conducted in 10 countries met inclusion criteria. Overall, test cost was one of the strongest drivers of preference, with participants preferring free or very low-cost testing. Confidentiality was a salient concern, particularly among key populations and persons who never tested. Participants in resource-limited settings preferred short travel distance and integration of HIV testing with other services. There was substantial heterogeneity across participant characteristics. For example, while women preferred home testing, high-risk groups (e.g. male porters, female bar workers) and men who had not tested in the last year preferred traveling a short distance for testing. HIV self-testing (HIVST) had high acceptability, particularly among those who had never HIV tested, although most users preferred blood-based sample collection over oral swabs. Participants highly valued post-test counselling availability after HIVST. INTERPRETATION Overall, participants value low-cost, confidential testing with short travel distance. HIVST is a promising strategy to increase testing coverage but post-test counseling and support should be made available. Educational campaigns to increase familiarity and build confidence in results of oral testing can improve the success of HIVST. DCEs conducted within clinic settings likely have limited generalizability to those not seeking care, particularly for key populations.
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Affiliation(s)
- Monisha Sharma
- Department of Global Health, University of Washington, School of Public Health, 908 Jefferson St, Seattle, WA 98104, United States
- Corresponding author.
| | - Jason J. Ong
- Department of Clinical Research and Development, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Central Clinical School, Monash University, Melbourne, Australia
| | - Connie Celum
- Department of Global Health, University of Washington, School of Public Health, 908 Jefferson St, Seattle, WA 98104, United States
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Fern Terris-Prestholt
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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8
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Ong JJ, De Abreu Lourenco R, Street D, Smith K, Jamil MS, Terris-Prestholt F, Fairley CK, McNulty A, Hynes A, Johnson K, Chow EPF, Bavinton B, Grulich A, Stoove M, Holt M, Kaldor J, Guy R. The Preferred Qualities of Human Immunodeficiency Virus Testing and Self-Testing Among Men Who Have Sex With Men: A Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:870-879. [PMID: 32762988 DOI: 10.1016/j.jval.2020.04.1826] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/27/2020] [Accepted: 04/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Human immunodeficiency virus self-testing (HIVST) is a promising approach to improve HIV testing coverage. We aimed to understand HIV testing preferences of men who have sex with men (MSM) to optimize HIVST implementation. METHODS Discrete choice experiments (DCEs) were conducted among HIV-negative MSM living in Australia and aged ≥18 years. Men completed 1 of 2 DCEs: DCETest for preferred qualities of HIV testing (price, speed, window period, test type, and collector of specimen) and DCEKits for preferred qualities of HIVST kits (price, location of access, packaging, and usage instructions). Latent class conditional logit regression was used to explore similarities (or "classes") in preference behavior. RESULTS Overall, the study recruited 1606 men: 62% born in Australia, who had an average age of 36.0 years (SD 11.7), and a self-reported median of 4 (interquartile range 2-8) sexual partners in the last 6 months. The respondents to DCETest was described by 4 classes: "prefer shorter window period" (36%), "prefer self-testing" (27%), "prefer highly accurate tests" (22%), and "prefer low prices" (15%). Respondents to DCEKits were described by 4 classes: "prefer low prices" (48%), "prefer retail access (from pharmacy or online stores)" (29%), "prefer access at sex venues" (15%), and "prefer to buy from healthcare staff" (12%). Preferences varied by when someone migrated to Australia, age, frequency of testing, and number of sexual partners. CONCLUSION A subset of MSM, particularly infrequent testers, value access to HIVST. Expanding access to HIVST kits through online portals and pharmacies and at sex venues should be considered.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Adam Hynes
- Thorne Harbour Health, Melbourne, Australia
| | | | | | | | | | | | - Martin Holt
- University of New South Wales, Sydney, Australia
| | - John Kaldor
- University of New South Wales, Sydney, Australia
| | - Rebecca Guy
- University of New South Wales, Sydney, Australia
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9
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Humphrey JM, Naanyu V, MacDonald KR, Wools-Kaloustian K, Zimet GD. Stated-preference research in HIV: A scoping review. PLoS One 2019; 14:e0224566. [PMID: 31665153 PMCID: PMC6821403 DOI: 10.1371/journal.pone.0224566] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
Discrete choice experiments (DCE), conjoint analysis (CA), and best-worst scaling (BWS) are quantitative techniques for estimating consumer preferences for products or services. These methods are increasingly used in healthcare research, but their applications within the field of HIV research have not yet been described. The objective of this scoping review was to systematically map the extent and nature of published DCE, CA, and BWS studies in the field of HIV and identify priority areas where these methods can be used in the future. Online databases were searched to identify published HIV-related DCE, CA and BWS studies in any country and year as the primary outcome. After screening 1,496 citations, 57 studies were identified that were conducted in 26 countries from 2000-2017. The frequency of published studies increased over time and covered HIV themes relating to prevention (n = 25), counselling and testing (n = 10), service delivery (n = 10), and antiretroviral therapy (n = 12). Most studies were DCEs (63%) followed by CA (37%) and BWS (4%). The median [IQR] sample size was 288 [138-496] participants, and 74% of studies used primary qualitative data to develop attributes. Only 30% of studies were conducted in sub-Saharan Africa where the burden of HIV is highest. Moreover, few studies surveyed key populations including men who have sex with men, transgender people, pregnant and postpartum women, adolescents, and people who inject drugs. These populations represent priorities for future stated-preference research. This scoping review can help researchers, policy makers, program implementers, and health economists to better understand the various applications of stated-preference research methods in the field of HIV.
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Affiliation(s)
- John M. Humphrey
- Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Violet Naanyu
- Department of Behavioral Sciences, Moi University, Eldoret, Uasin Gishu County, Kenya
- AMPATH Program, Eldoret, Uasin Gishu County, Kenya
| | - Katherine R. MacDonald
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, United States of America
| | - Kara Wools-Kaloustian
- Department of Medicine, Indiana University, Indianapolis, Indiana, United States of America
| | - Gregory D. Zimet
- Department of Pediatrics, Indiana University, Indianapolis, Indiana, United States of America
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10
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Ong JJ, Neke N, Wambura M, Kuringe E, Grund JM, Plotkin M, d'Elbée M, Torres-Rueda S, Mahler HR, Weiss HA, Terris-Prestholt F. Use of Lotteries for the Promotion of Voluntary Medical Male Circumcision Service: A Discrete-Choice Experiment among Adult Men in Tanzania. Med Decis Making 2019; 39:474-485. [PMID: 31179868 DOI: 10.1177/0272989x19852095] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Voluntary medical male circumcision (VMMC) is effective in reducing the risk of human immunodeficiency virus (HIV). However, countries like Tanzania have high HIV prevalence but low uptake of VMMC. We conducted a discrete-choice experiment to evaluate the preferences for VMMC service attributes in a random sample of 325 men aged 18 years or older from the general population in 2 Tanzanian districts, Njombe and Tabora. We examined the preference for financial incentives in the form of a lottery ticket or receiving a guaranteed transport voucher for attendance at a VMMC service. We created a random-parameters logit model to account for individual preference heterogeneity and a latent class analysis model for identifying groups of men with similar preferences to test the hypothesis that men who reported sexually risky behaviors (i.e., multiple partners and any condomless sex in the past 12 months) may have a preference for participation in a lottery-based incentive. Most men preferred a transport voucher (84%) over a lottery ticket. We also found that offering a lottery-based financial incentive may not differentially attract those with greater sexual risk. Our study highlights the importance of gathering local data to understand preference heterogeneity, particularly regarding assumptions around risk behaviors.
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Affiliation(s)
- Jason J Ong
- Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.,Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK.,Central Clinical School, Monash University, Australia
| | - Nyasule Neke
- National Institute of Medical Research, Mwanza, Tanzania
| | - Mwita Wambura
- National Institute of Medical Research, Mwanza, Tanzania
| | | | - Jonathan M Grund
- Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Marc d'Elbée
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Sergio Torres-Rueda
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Helen A Weiss
- MRC Tropical Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Fern Terris-Prestholt
- Department of Global Health and Development, Faculty of Public Health Policy, London School of Hygiene and Tropical Medicine, London, UK
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11
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Gray BJ, Jones AT, Couzens Z, Sagar T, Jones D. University students' behaviours towards accessing sexual health information and treatment. Int J STD AIDS 2019; 30:671-679. [PMID: 30961468 DOI: 10.1177/0956462419828866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Globally, it is widely recognised that young people (those under the age of 25 years) are at a higher risk of developing sexually transmitted infections (STIs). The majority of university students studying in the UK fall within this age bracket, and to help prevent such high incidence of STIs in this age group, it is essential that advice and treatment, if required, are obtained from reliable sources. This study sought to explore sources of sexual heath advice and treatment for students at Welsh universities (n = 3007). The main sources of advice were identified as the internet (49.1%) and GP/family doctors (38.9%), whilst local sexual health clinics (24.9%) and GP/family doctor services (20.2%) were the main sources for treatment in students. Males were more likely than females to report never needing advice (AOR 2.74; CI = 2.24-3.35) or requiring treatment (AOR 1.37; CI = 1.17-1.60). The apparent lack of engagement with these services by male students is a cause for concern, although one possible solution could be to further develop online methods to increase uptake of testing. Furthermore, the popularity of the internet for advice provides a timely reminder that regulation of online sexual health information is critical.
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Affiliation(s)
- Benjamin J Gray
- 1 Policy, Research and International Development, Public Health Wales, Cardiff, UK
| | - Adam T Jones
- 1 Policy, Research and International Development, Public Health Wales, Cardiff, UK
| | - Zoë Couzens
- 2 Health Protection, Public Health Wales, Cardiff, UK
| | - Tracey Sagar
- 3 Centre for Criminal Justice and Criminology, Swansea University, Swansea, UK
| | - Debbie Jones
- 3 Centre for Criminal Justice and Criminology, Swansea University, Swansea, UK
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12
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Eaton S, Biggerstaff D, Petrou S, Osipenko L, Gibbs J, Estcourt CS, Sadiq T, Szczepura A. Young people's preferences for the use of emerging technologies for asymptomatic regular chlamydia testing and management: a discrete choice experiment in England. BMJ Open 2019; 9:e023663. [PMID: 30700477 PMCID: PMC6352830 DOI: 10.1136/bmjopen-2018-023663] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 10/30/2018] [Accepted: 11/05/2018] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To undertake a comprehensive assessment of the strength of preferences among young people for attributes of emerging technologies for testing and treatment of asymptomatic chlamydia. DESIGN Discrete choice experiment (DCE) with sequential mixed methods design. A staged approach to selection of attributes/levels included two literature reviews, focus groups with young people aged 16-24 years (n=21), experts' review (n=13) and narrative synthesis. Cognitive testing was undertaken to pilot and adapt the initial questionnaire. Online national panel was used for final DCE survey to maximise generalisability. Analysis of questionnaire responses used multinomial logit models and included validity checks. SETTING England. PARTICIPANTS 1230 young people aged 16-24 from a national online panel (completion rate 73%). OUTCOME MEASURES ORs for service attributes in relation to reference levels. RESULTS The strongest attribute influencing preferences was chlamydia test accuracy (OR 3.24, 95% CI 3.13 to 3.36), followed by time to result (OR 1.81, 95% CI 1.71 to 1.91). Respondents showed a preference for remote chlamydia testing options (self-testing, self-sampling and postal testing) over attendance at a testing location. For accessing treatment following a positive test result, there was a general preference for online (OR 1.21, 95% CI 1.15 to 1.28) versus traditional general practitioner (OR 1.18, 95% CI 1.12 to 1.24) or pharmacy (OR 1.15, 95% CI 1.10 to 1.22) over clinic services. For accessing a healthcare professional and receipt of antibiotics, there was little difference in preferences between options. CONCLUSIONS Both test accuracy and very short intervals between testing and results were important factors for young people when deciding whether to undergo a routine test for asymptomatic chlamydia, with test accuracy being more important. These findings should assist technology developers, policymakers, commissioners and service providers to optimise technology adoption in service redesign, although use of an online panel may limit generalisability of findings to other populations.
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Affiliation(s)
- Sue Eaton
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Stavros Petrou
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Leeza Osipenko
- Scientific Advice, National Institute for Health and Care Excellence, London, UK
| | - Jo Gibbs
- Research Department of Infection and Population Health, University College London, London, UK
| | | | - Tariq Sadiq
- Applied Diagnostic Research and Evaluation Unit, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Ala Szczepura
- Enterprise and Innovation Group, Coventry University, Coventry, UK
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13
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Martin-Smith HA, Okpo EA, Bull ER. Exploring psychosocial predictors of STI testing in University students. BMC Public Health 2018; 18:664. [PMID: 29843658 PMCID: PMC5975527 DOI: 10.1186/s12889-018-5587-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background To explore university students’ Sexually Transmitted Infection (STI) testing knowledge, psychosocial and demographic predictors of past STI testing behaviour, intentions to have an STI test, and high risk sexual behaviour, to inform interventions promoting STI testing in this population. Methods A cross-sectional, quantitative online survey was conducted in March 2016, recruiting university students from North East Scotland via an all-student email. The anonymous questionnaire assessed student demographics (e.g. sex, ethnicity, age), STI testing behaviours, sexual risk behaviours, knowledge and five psychological constructs thought to be predictive of STI testing from theory and past research: attitudes, perceived susceptibility to STIs, social norms, social fear and self-efficacy. Results The sample contained 1294 sexually active students (response rate 10%) aged 18–63, mean age = 23.61 (SD 6.39), 888 (69%) were female. Amongst participants, knowledge of STIs and testing was relatively high, and students held generally favourable attitudes. 52% reported ever having an STI test, 13% intended to have one in the next month; 16% reported unprotected sex with more than one ‘casual’ partner in the last six months. Being female, older, a postgraduate, longer UK residence, STI knowledge, perceived susceptibility, subjective norms, attitudes and self-efficacy all positively predicted past STI testing behaviour (p < 0.01). Perceived susceptibility to STIs and social norms positively predicted intentions to have an STI test in the next month (p < 0.05); perceived susceptibility also predicted past high-risk sexual behaviour (p < 0.01). Conclusions Several psychosocial predictors of past STI testing, of high-risk sexual behaviour and future STI intentions were identified. Health promotion STI testing interventions could focus on male students and target knowledge, attitude change, and increasing perceived susceptibility to STIs, social norms and self-efficacy towards STI-testing. Electronic supplementary material The online version of this article (10.1186/s12889-018-5587-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - E A Okpo
- NHS Grampian, Public Health Directorate, Aberdeen, UK
| | - E R Bull
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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14
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Lampejo T, Turner R, Roberts C, Allen K, Watson L, Caverley-Frost L, Scott P, Ostridge E, Cooney G, Hardy J, Nulty K, Day S. Novel outreach settings to enhance sexually transmitted infection/HIV awareness, diagnosis and treatment in hard-to-reach populations. Int J STD AIDS 2017; 29:266-272. [PMID: 28768469 DOI: 10.1177/0956462417723816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Despite recent rises in the number of cases of sexually transmitted infections (STIs) such as syphilis and gonorrhoea in England and increasing rates of HIV diagnosis among several men who have sex with men populations, many individuals are still not engaging with sexual health services. The John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London set up outreach clinics at the two world's largest adult lifestyle exhibitions in 2013 and 2015. This was the first time that a sexual health screening and promotion service was available at these large-scale (over 10,000 attendees at each) adult lifestyle events. A total of 381 individuals underwent STI screening across the two events. Nineteen (5.0%) patients were diagnosed with an infection. Twelve (3.1%) patients with Chlamydia trachomatis, three (0.8%) patients with syphilis, one (0.3%) patient with Neisseria gonorrhoeae, one (0.3%) patient with HIV, one (0.3%) patient with hepatitis B and one (0.3%) patient with hepatitis C. All 19 patients were promptly contacted with their results and had arrangements made for treatment or were referred for specialist follow up. Where possible, contact tracing was also performed. Implementing such outreach-based projects is challenged by lack of on-site laboratory support, high staffing demands and potentially high costs. However, we achieved a total HIV screening uptake rate of 94.5% amongst our outreach clinic attendees (versus 67% nationally in conventional sexual health clinic attendees) with an HIV positivity rate of 0.3% (versus 0.2% nationally in high HIV prevalence band populations). Additionally, 30.7% had never been tested for HIV previously (versus 20.7% nationally). Our work demonstrates that these strategies can help to address issues related to lack of STI/HIV screening in hard-to-reach populations and promote risk reduction behaviour.
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Affiliation(s)
- T Lampejo
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - R Turner
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - C Roberts
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - K Allen
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - L Watson
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - L Caverley-Frost
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - P Scott
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - E Ostridge
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - G Cooney
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - J Hardy
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - K Nulty
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
| | - S Day
- John Hunter Clinic for Sexual Health, Chelsea and Westminster Hospital, London, UK
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15
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Han L, Wei C, Muessig KE, Bien CH, Meng G, Emch ME, Tucker JD. HIV test uptake among MSM in China: Implications for enhanced HIV test promotion campaigns among key populations. Glob Public Health 2017; 12:31-44. [PMID: 26785328 PMCID: PMC4955642 DOI: 10.1080/17441692.2015.1134612] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Despite global efforts to increase HIV test uptake among men who have sex with men (MSM), social stigma and negative attitudes toward homosexuality hinder the effectiveness of traditional test promotion campaigns. Increasing HIV test uptake requires greater understanding of the conditions that facilitate decisions to get tested. We conducted an online survey hosted by two of the most highly frequented MSM web portals in China. A generalised ordered logistic regression analysis was conducted to determine factors associated with HIV testing behaviour. Compared to men who had never tested for HIV, men who had tested in the past year were more likely to have never engaged in sex with women, have multiple male sex partners in the past 3 months and have disclosed their sexual orientation to others. MSM found testing at local Chinese Centers for Disease Control and Prevention (80.7%), gay men's community-based organisations (80.2%) and public hospitals (70.9%) to be acceptable, while saunas (50.5%) and gay bars (41.8%) were found to be unacceptable testing venues. Our study shows that MSM in China prefer to test at venues that guarantee confidentiality, quality and quick results. Our study also suggests that self-testing may be a feasible approach to increase test uptake.
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Affiliation(s)
- Larry Han
- University of North Carolina Project – China, Guangzhou, People’s Republic of China
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Chongyi Wei
- Department of Epidemiology and Biostatistics & Global Health Sciences, University of California – San Francisco, San Francisco, CA, USA
| | - Kathryn E. Muessig
- University of North Carolina Project – China, Guangzhou, People’s Republic of China
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cedric H. Bien
- University of North Carolina Project – China, Guangzhou, People’s Republic of China
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gang Meng
- Guangtong – Lingnan MSM Community Support Center, Guangzhou, People’s Republic of China
| | - Michael E. Emch
- Department of Geography, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joseph D. Tucker
- University of North Carolina Project – China, Guangzhou, People’s Republic of China
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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16
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Gibbs J, Sutcliffe LJ, Gkatzidou V, Hone K, Ashcroft RE, Harding-Esch EM, Lowndes CM, Sadiq ST, Sonnenberg P, Estcourt CS. The eClinical Care Pathway Framework: a novel structure for creation of online complex clinical care pathways and its application in the management of sexually transmitted infections. BMC Med Inform Decis Mak 2016; 16:98. [PMID: 27448797 PMCID: PMC4957844 DOI: 10.1186/s12911-016-0338-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 07/13/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Despite considerable international eHealth impetus, there is no guidance on the development of online clinical care pathways. Advances in diagnostics now enable self-testing with home diagnosis, to which comprehensive online clinical care could be linked, facilitating completely self-directed, remote care. We describe a new framework for developing complex online clinical care pathways and its application to clinical management of people with genital chlamydia infection, the commonest sexually transmitted infection (STI) in England. METHODS Using the existing evidence-base, guidelines and examples from contemporary clinical practice, we developed the eClinical Care Pathway Framework, a nine-step iterative process. Step 1: define the aims of the online pathway; Step 2: define the functional units; Step 3: draft the clinical consultation; Step 4: expert review; Step 5: cognitive testing; Step 6: user-centred interface testing; Step 7: specification development; Step 8: software testing, usability testing and further comprehension testing; Step 9: piloting. We then applied the Framework to create a chlamydia online clinical care pathway (Online Chlamydia Pathway). RESULTS Use of the Framework elucidated content and structure of the care pathway and identified the need for significant changes in sequences of care (Traditional: history, diagnosis, information versus Online: diagnosis, information, history) and prescribing safety assessment. The Framework met the needs of complex STI management and enabled development of a multi-faceted, fully-automated consultation. CONCLUSION The Framework provides a comprehensive structure on which complex online care pathways such as those needed for STI management, which involve clinical services, public health surveillance functions and third party (sexual partner) management, can be developed to meet national clinical and public health standards. The Online Chlamydia Pathway's standardised method of collecting data on demographics and sexual behaviour, with potential for interoperability with surveillance systems, could be a powerful tool for public health and clinical management.
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Affiliation(s)
- Jo Gibbs
- />Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
- />Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, UK
| | - Lorna J. Sutcliffe
- />Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Voula Gkatzidou
- />School of Information Systems & Computing, Brunel University London, Uxbridge, UK
| | - Kate Hone
- />School of Information Systems & Computing, Brunel University London, Uxbridge, UK
| | | | | | | | - S. Tariq Sadiq
- />Institute of Infection and Immunity, St George’s, University of London, London, UK
| | - Pam Sonnenberg
- />Research Department of Infection and Population Health, University College London, Mortimer Market Centre, off Capper Street, London, UK
| | - Claudia S. Estcourt
- />Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University of London, London, UK
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