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Give C, Morris C, Murray J, José B, Machava R, Wayal S. Sociocultural understanding of Tuberculosis and implications for care-seeking among adults in the province of Zambezia, Mozambique: Qualitative research. PLoS One 2024; 19:e0289928. [PMID: 38236935 PMCID: PMC10795997 DOI: 10.1371/journal.pone.0289928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/29/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION Mozambique has a high burden of Tuberculosis (TB) with an incidence of 368 per 100,000 population in 2020, coupled with a low all-form TB detection rate. The COVID-19 pandemic has exacerbated delays in timely diagnosis and treatment of new TB cases. Promoting active TB case finding is a national priority in Mozambique. We conducted qualitative research to explore factors influencing TB testing in Zambezia province in Mozambique. MATERIALS AND METHODS One-to-one, semi-structured, audio-recorded telephone interviews were conducted to explore TB-related knowledge, and barriers and facilitators to TB testing. A sample of two TB Program staff, two community providers of TB services, and 19 community members (10 women and 9 men) was recruited, with support from provincial government TB staff, from four districts in Zambezia with a high TB burden. Interviews were transcribed verbatim, and thematic analysis was conducted. The Mozambican National Bioethics Committee for Health approved the study protocol. RESULTS Our study highlights that knowledge about TB symptoms and its causes is low, which could delay timely TB testing. Sociocultural beliefs often implicate certain types of sexual activity and women as causes of TB symptoms; for example, having sex with a widow who has not been traditionally purified, or with a woman who has had an abortion. Therefore, people usually tend to first seek care from traditional healers instead of going to a health facility. Additionally, stigma associated with HIV and TB also delays care seeking. Gender-related disparities in TB care seeking were also evident. CONCLUSIONS This study provides valuable insights into how healthcare seeking for TB is influenced by sociocultural understanding of symptoms and gender dynamics. Therefore, interventions to promote timely and appropriate care seeking for TB should be contextually tailored, culturally appropriate, and gender sensitive.
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Affiliation(s)
- Celso Give
- Development Media International, Maputo, Mozambique
| | | | - Joanna Murray
- Development Media International, London, United Kingdom
| | - Benedita José
- National Tuberculosis Control Programme, Ministry of Health, Maputo, Mozambique
| | - Raimundo Machava
- National Tuberculosis Control Programme, Ministry of Health, Maputo, Mozambique
| | - Sonali Wayal
- Development Media International, London, United Kingdom
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Hayes R, Nutland W, Rayment M, Wayal S, Apea V, Clarke A, McOwan A, Sullivan A, Desai M, Jajja A, Rice B, Horne R, McCormack S, Gafos M. "Sex without fear": exploring the psychosocial impact of oral HIV pre-exposure prophylaxis on gay men in England. AIDS Res Ther 2023; 20:81. [PMID: 37964322 PMCID: PMC10648634 DOI: 10.1186/s12981-023-00568-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 09/02/2023] [Indexed: 11/16/2023] Open
Abstract
Gay, bisexual, and other men who have sex with men (GBMSM) experience a high prevalence of psychosocial health problems, such as harmful substance use and depression, as well as being disproportionately affected by HIV. HIV Pre-Exposure Prophylaxis (PrEP) may provide psychosocial benefits beyond its intended purpose of reducing HIV infection. We explore the psychosocial impact of oral PrEP use on gay men in England using qualitative data from the PROUD study. From February 2014 to January 2016, semi-structured in-depth interviews were conducted with 40 gay men and one trans woman. Participants were purposively recruited based on trial arm allocation, adherence, and sexual risk behaviours. By removing HIV risk from sex, PrEP improves users' wellbeing by reducing HIV-related anxiety and internalised stigma and increasing HIV prevention self-efficacy, sexual pleasure, and intimacy. In turn, these psychological changes may influence behaviour in the form of greater sexual freedom, reduced harmful drug use, and more protective sexual health behaviours. However, PrEP may create internal conflict for some gay men, due to its disruption of social norms around condom use and its perceived influence on their sexual behaviour leading to reduced condom self-efficacy. These findings provide a baseline of PrEP's psychosocial impact amongst some of the first PrEP users in England and supports calls to consider the psychosocial impact of PrEP in prescribing guidelines.
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Affiliation(s)
- Rosalie Hayes
- Wolfson Institute of Population Health, Queen Mary University of London, 58 Turner Street, London, E1 2AB, UK
| | | | - Michael Rayment
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- Institute for Global Health, Mortimer Market Centre, University College London, London, UK
| | - Vanesa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, UK
| | - Amanda Clarke
- Department of HIV, Sexual Health and Contraception, Royal Sussex County Hospital, University Hospitals Sussex NHS Trust, Brighton, UK
| | - Alan McOwan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Ann Sullivan
- Directorate of HIV and GU Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- STI & HIV Division, Blood Safety, Health Security Agency, London, UK
| | - Andrew Jajja
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Brian Rice
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Rob Horne
- School of Pharmacy, University College London, London, UK
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, University College London, London, UK.
| | - Mitzy Gafos
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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3
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Arnold-Forster D, Horne R, Nutland W, Wayal S, Rayment M, Rae C, Desai M, Clarke A, Sullivan A, McCormack S, Gafos M. Perceptions and Practicalities Influencing Pre-exposure Prophylaxis Adherence Among Men Who Have Sex with Men in England. AIDS Behav 2022; 26:2768-2782. [PMID: 35182281 PMCID: PMC9252952 DOI: 10.1007/s10461-022-03624-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 12/27/2022]
Abstract
PrEP is highly effective for HIV prevention but requires adequate adherence. In this paper we use the perceptions and practicalities approach (PAPA) to identify factors that influenced PrEP adherence using qualitative data from the PROUD study. From February 2014 to January 2016, we interviewed 41 gay, bisexual and other men-who-have-sex-with-men and one trans woman who were enrolled in the study. We purposively recruited participants for interview based on trial arm allocation, adherence and sexual risk behaviours. The interviews were conducted in English, audio-recorded, transcribed, coded and analysed using framework analysis. Participants in general were highly motivated to use and adhere to PrEP, and this was linked to strong perceptions of personal necessity for PrEP as they felt at risk of HIV and viewed PrEP as highly effective. On the other hand, concerns about side effects and HIV resistance did inhibit PrEP initiation and adherence although this was uncommon. Practical factors such as daily routine, existing habitual pill-taking and pill storage impacted adherence. Drug and alcohol use rarely caused participants to miss doses. These findings indicate that using the principals of PAPA to unpick influencers of PrEP use, could help tailor adherence support in PrEP programmes.
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Affiliation(s)
- Dora Arnold-Forster
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK
| | - Robert Horne
- School of Pharmacy, University College London, London, UK
| | | | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Michael Rayment
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Caroline Rae
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Monica Desai
- National Institute for Health and Care Excellence, London, UK
| | - Amanda Clarke
- Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK
| | - Ann Sullivan
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sheena McCormack
- Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Mitzy Gafos
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Kepple Street, London, WC1E 7HT, UK.
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials and Methodology, University College London, London, UK.
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4
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Wayal S, Estcourt CS, Mercer CH, Saunders J, Low N, McKinnon T, Symonds M, Cassell JA. Optimising partner notification outcomes for bacterial sexually transmitted infections: a deliberative process and consensus, United Kingdom, 2019. Euro Surveill 2022; 27. [PMID: 35057899 PMCID: PMC8804665 DOI: 10.2807/1560-7917.es.2022.27.3.2001895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Partner notification (PN) is an essential element of sexually transmitted infection (STI) control. It enables identification, treatment and advice for sexual contacts who may benefit from additional preventive interventions such as HIV pre- and post-exposure prophylaxis. PN is most effective in reducing STI transmission when it reaches individuals who are most likely to have an STI and to engage in sexual behaviour that facilitates STI transmission, including having multiple and/or new sex partners. Outcomes of PN practice need to be measurable in order to inform standards. They need to address all five stages in the cascade of care: elicitation of partners, establishing contactable partners, notification, testing and treatment. In the United Kingdom, established outcome measures cover only the first three stages and do not take into account the type of sexual partnership. We report an evidence-based process to develop new PN outcomes and inform standards of care. We undertook a systematic literature review, evaluation of published information on types of sexual partnership and a modified Delphi process to reach consensus. We propose six new PN outcome measures at five stages of the cascade, including stratification by sex partnership type. Our framework for PN outcome measurement has potential to contribute in other domains, including Covid-19 contact tracing.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
| | - Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Catherine H Mercer
- Institute for Global Health, University College London, London, United Kingdom
| | - John Saunders
- Institute for Global Health, University College London, London, United Kingdom
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Tamsin McKinnon
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Merle Symonds
- Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, United Kingdom
| | - Jackie A Cassell
- Brighton and Sussex Medical School, Falmer, East Sussex, United Kingdom
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Howarth AR, Saunders J, Reid D, Kelly I, Wayal S, Weatherburn P, Hughes G, Mercer CH. 'Stay at home …': exploring the impact of the COVID-19 public health response on sexual behaviour and health service use among men who have sex with men: findings from a large online survey in the UK. Sex Transm Infect 2021; 98:346-352. [PMID: 34544888 PMCID: PMC8457994 DOI: 10.1136/sextrans-2021-055039] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/20/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The first UK national lockdown began on 23 March 2020, in response to the COVID-19 pandemic, and led to reduced STI/HIV service provision in the UK. We investigated sexual behaviour, use and need for sexual healthcare during the pandemic. METHODS Participants (N=2018), including men (cis/transgender), transwomen and gender-diverse people reporting sex with another man (cis/transgender) or non-binary person assigned male at birth, completed an online cross-sectional survey (23 June 2020-14 July 2020), in response to adverts on social media and dating apps.Sexual behaviour, service use and unmet need for STI testing (any new male and/or multiple condomless anal sex (CAS) partners without STI testing) in the 3 months since lockdown began were examined and compared using multivariable analyses with an equivalent 3-month period in a 2017 survey (N=1918), conducted by the same research team. RESULTS Since lockdown began, 36.7% of participants reported one or more new partners, 17.3% reported CAS with multiple partners, 29.7% HIV testing (among 1815 of unknown/negative status), 24.9% STI testing and 15.4% using pre-exposure prophylaxis (PrEP).Since lockdown began, 25.3% of participants had unmet need for STI testing. This was more likely among Asian versus white participants (adjusted OR (aOR)=1.76, (1.14 to 2.72), p=0.01); for participants living in Scotland (aOR=2.02, (1.40 to 2.91), p<0.001) or Northern Ireland (aOR=1.93, (1.02-3.63), p=0.04) versus England; and for those living with HIV (aOR=1.83, (1.32 to 2.53), p<0.001).Compared to 2017, the equivalent 2020 subsample were less likely to report new male partners (46.8% vs 71.1%, p<0.001), multiple CAS partners (20.3% vs 30.8%, p<0.001) and have unmet need for STI testing (32.8% vs 42.5%, p<0.001) in the past 3 months. CONCLUSIONS We found potential for ongoing STI/HIV transmission among men who have sex with men during the initial UK lockdown, despite reduced sexual activity, and inequalities in service access. These findings will support public health planning to mitigate health risks during and after the COVID-19 response.
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Affiliation(s)
- Alison R Howarth
- UCL Institute for Global Health, University College London, London, UK .,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK
| | - John Saunders
- UCL Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK.,Blood Safety, Hepatitis, STIs and HIV Division, National Infection Service, Public Health England, London, UK
| | - David Reid
- UCL Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Isabelle Kelly
- UCL Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK
| | - Sonali Wayal
- UCL Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK
| | - Peter Weatherburn
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK.,Blood Safety, Hepatitis, STIs and HIV Division, National Infection Service, Public Health England, London, UK
| | - Catherine H Mercer
- UCL Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England, London, UK
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6
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Estcourt CS, Flowers P, Cassell JA, Pothoulaki M, Vojt G, Mapp F, Woode-Owusu M, Low N, Saunders J, Symonds M, Howarth A, Wayal S, Nandwani R, Brice S, Comer A, Johnson AM, Mercer CH. Going beyond 'regular and casual': development of a classification of sexual partner types to enhance partner notification for STIs. Sex Transm Infect 2021; 98:108-114. [PMID: 33927009 PMCID: PMC8862076 DOI: 10.1136/sextrans-2020-054846] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/03/2021] [Accepted: 02/27/2021] [Indexed: 12/05/2022] Open
Abstract
Objectives To develop a classification of sexual partner types for use in partner notification (PN) for STIs. Methods A four-step process: (1) an iterative synthesis of five sources of evidence: scoping review of social and health sciences literature on partner types; analysis of relationship types in dating apps; systematic review of PN intervention content; and review of PN guidelines; qualitative interviews with public, patients and health professionals to generate an initial comprehensive classification; (2) multidisciplinary clinical expert consultation to revise the classification; (3) piloting of the revised classification in sexual health clinics during a randomised controlled trial of PN; (4) application of the Theoretical Domains Framework (TDF) to identify index patients’ willingness to engage in PN for each partner type. Results Five main partner types emerged from the evidence synthesis and consultation: ‘established partner’, ‘new partner’, ‘occasional partner’, ‘one-off partner’ and ‘sex worker’. The types differed across several dimensions, including likely perceptions of sexual exclusivity, likelihood of sex reoccurring between index patient and sex partner. Sexual health professionals found the classification easy to operationalise. During the trial, they assigned all 3288 partners described by 2223 index patients to a category. The TDF analysis suggested that the partner types might be associated with different risks of STI reinfection, onward transmission and index patients’ engagement with PN. Conclusions We developed an evidence-informed, useable classification of five sexual partner types to underpin PN practice and other STI prevention interventions. Analysis of biomedical, psychological and social factors that distinguish different partner types shows how each could warrant a tailored PN approach. This classification could facilitate the use of partner-centred outcomes. Additional studies are needed to determine the utility of the classification to improve measurement of the impact of PN strategies and help focus resources.
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Affiliation(s)
- Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Paul Flowers
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
| | - Jackie A Cassell
- Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, Brighton and Hove, UK
| | - Maria Pothoulaki
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Gabriele Vojt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Fiona Mapp
- Institute for Global Health, University College London, London, UK
| | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - John Saunders
- Institute for Global Health, University College London, London, UK
- Blood Safety, Hepatitis, STI & HIV Division, Public Health England, London, UK
| | - Merle Symonds
- Department of Sexual Health, West Sussex Health and Social Care NHS Trust, Worthing, West Sussex, UK
| | - Alison Howarth
- Institute for Global Health, University College London, London, UK
| | | | - Rak Nandwani
- Sandyford Sexual Health Service, NHS Greater Glasgow and Clyde, Glasgow, UK
| | | | - Alex Comer
- Central and North West London NHS Foundation Trust, London, UK
| | - Anne M Johnson
- Department of Infection & Population Health, University College London, London, UK
| | - Catherine H Mercer
- Centre for Sexual Health and HIV Research, University College London, London, UK
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Bailey JV, Wayal S, Aicken CR, Webster R, Mercer CH, Nazareth I, Rait G, Peacock R, Murray E. Interactive digital interventions for prevention of sexually transmitted HIV. AIDS 2021; 35:643-653. [PMID: 33259345 PMCID: PMC7924981 DOI: 10.1097/qad.0000000000002780] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/11/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Digital technology offers good opportunities for HIV prevention. This systematic review assesses the effectiveness of interactive digital interventions (IDIs) for prevention of sexually transmitted HIV. METHODS We conducted a systematic search for randomized controlled trials (RCTs) of IDIs for HIV prevention, defining 'interactive' as producing personally tailored material. We searched databases including the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, PsycINFO, grey literature, reference lists, and contacted authors if needed.Two authors screened abstracts, applied eligibility and quality criteria and extracted data. Meta-analyses used random-effects models with standardized mean differences (SMD) for continuous outcomes and odds ratios (OR) for binary outcomes, assessing heterogeneity using the I2 statistic. RESULTS We included 31 RCTs of IDIs for HIV prevention. Meta-analyses of 29 RCTs comparing IDIs with minimal interventions (e.g. leaflet, waiting list) showed a moderate increase in knowledge (SMD 0.56, 95% CI 0.33 to 0.80), no effect on self-efficacy (SMD 0.13, 95% CI 0.00 to 0.27), a small improvement in intention (SMD 0.16, 95% CI 0.06 to 0.26), improvement in HIV prevention behaviours (OR 1.28, 95% CI 1.04 to 1.57) and a possible increase in viral load, but this finding is unreliable.We found no evidence of difference between IDIs and face-to-face interventions for knowledge, self-efficacy, intention, or HIV-related behaviours in meta-analyses of five small RCTs. We found no health economic studies. CONCLUSION There is good evidence that IDIs have positive effects on knowledge, intention and HIV prevention behaviours. IDIs are appropriate for HIV prevention in a variety of settings.Supplementary Video Abstract, http://links.lww.com/QAD/B934.
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Affiliation(s)
- Julia V. Bailey
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Sonali Wayal
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
- Development Media International
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Catherine R.H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
- School of Health Sciences, University of Brighton, Falmer, Brighton
| | - Rosie Webster
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London
| | - Irwin Nazareth
- Research Department of Primary Care and Population Health, University College London
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London
| | - Richard Peacock
- Whittington Health Library, The Whittington Hospital, London, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, University College London
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Bardsley M, Wayal S, Blomquist P, Mohammed H, Mercer CH, Hughes G. Improving our understanding of the disproportionate incidence of STIs in heterosexual-identifying people of black Caribbean heritage: findings from a longitudinal study of sexual health clinic attendees in England. Sex Transm Infect 2021; 98:23-31. [PMID: 33514680 PMCID: PMC8785042 DOI: 10.1136/sextrans-2020-054784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 11/20/2022] Open
Abstract
Objective In England, people of black minority ethnicities are at elevated risk of STI diagnosis, especially those of black Caribbean (BC) heritage. Understanding the factors that predict STI acquisition in this population is key to inform prevention measures. We examined the differences in predictors of incident STI diagnoses across ethnic groups in people attending sexual health clinics (SHCs). Methods Responses from an attitudinal and behavioural survey run in 16 English SHCs (May–September 2016) were linked to routinely collected national surveillance data on bacterial STI or trichomoniasis diagnoses. Cox proportional hazards models investigated the relationship between participant characteristics and rate of incident STI in the 18 months after survey completion for all heterosexual participants (N=2940) and separately for heterosexual BC (N=484) and white British/Irish (WBI, N=1052) participants. Results We observed an overall STI incidence of 5.7 per 100 person-years (95% CI 5.1 to 6.5). STI incidence was higher in participants of BC ethnicity (BC, 12.1 per 100 person-years, 95% CI 9.7 to 15.1; WBI, 3.2 per 100 person-years, 95% CI 2.4 to 4.2), even in adjusted analysis (BC adjusted HR (aHR), 2.60, p<0.001, compared with WBI). In models stratified by ethnicity, having had two or more previous STI episodes in the past year was the strongest predictor of incident STI for both BC (aHR 5.81, p<0.001, compared with no previous episodes) and WBI (aHR 29.9, p<0.001) participants. Aside from younger age (aHR 0.96 for increasing age in years, p=0.04), we found no unique predictors of incident STI for BC participants. Conclusions Incident STI diagnoses among SHC attendees in England were considerably higher in study participants of BC ethnicity, but we found no unique clinical, attitudinal or behavioural predictors explaining the disproportionate risk. STI prevention efforts for people of BC ethnicity should be intensified and should include tailored public health messaging to address sexual health inequalities in this underserved population.
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Affiliation(s)
- Megan Bardsley
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK .,National Infection Service, Blood Safety, Hepatitis & HIV Division, Public Health England, London, UK
| | - Sonali Wayal
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK.,Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Paula Blomquist
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK.,National Infection Service, Blood Safety, Hepatitis & HIV Division, Public Health England, London, UK
| | - Hamish Mohammed
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK.,National Infection Service, Blood Safety, Hepatitis & HIV Division, Public Health England, London, UK
| | - Catherine H Mercer
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK.,Centre for Population Research in Sexual Health and HIV, University College London, London, UK
| | - Gwenda Hughes
- Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections at University College London, in partnership with Public Health England and in collaboration with London School of Hygiene & Tropical Medicine, National Institute for Health Research, London, UK.,National Infection Service, Blood Safety, Hepatitis & HIV Division, Public Health England, London, UK
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9
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Estcourt CS, Howarth AR, Copas A, Low N, Mapp F, Woode Owusu M, Flowers P, Roberts T, Mercer CH, Wayal S, Symonds M, Nandwani R, Saunders J, Johnson AM, Pothoulaki M, Althaus C, Pickering K, McKinnon T, Brice S, Comer A, Tostevin A, Ogwulu CD, Vojt G, Cassell JA. Accelerated partner therapy (APT) partner notification for people with Chlamydia trachomatis: protocol for the Limiting Undetected Sexually Transmitted infections to RedUce Morbidity (LUSTRUM) APT cross-over cluster randomised controlled trial. BMJ Open 2020; 10:e034806. [PMID: 32229523 PMCID: PMC7170609 DOI: 10.1136/bmjopen-2019-034806] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Partner notification (PN) is a process aiming to identify, test and treat the sex partners of people (index patients) with sexually transmitted infections (STIs). Accelerated partner therapy (APT) is a PN method whereby healthcare professionals assess sex partners, by telephone consultation, before giving the index patient antibiotics and STI self-sampling kits to deliver to their sex partner(s). The Limiting Undetected Sexually Transmitted infections to RedUce Morbidity programme aims to determine the effectiveness of APT in heterosexual women and men with chlamydia and determine whether APT could affect Chlamydia trachomatis transmission at population level. METHODS AND ANALYSIS This protocol describes a cross-over cluster randomised controlled trial of APT, offered as an additional PN method, compared with standard PN. The trial is accompanied by an economic evaluation, transmission dynamic modelling and a qualitative process evaluation involving patients, partners and healthcare professionals. Clusters are 17 sexual health clinics in areas of England and Scotland with contrasting patient demographics. We will recruit 5440 heterosexual women and men with chlamydia, aged ≥16 years.The primary outcome is the proportion of index patients testing positive for C. trachomatis 12-16 weeks after the PN consultation. Secondary outcomes include: proportion of sex partners treated; cost effectiveness; model-predicted chlamydia prevalence; experiences of APT.The primary outcome analysis will be by intention-to-treat, fitting random effects logistic regression models that account for clustering of index patients within clinics and trial periods. The transmission dynamic model will be used to predict change in chlamydia prevalence following APT. The economic evaluation will use mathematical modelling outputs, taking a health service perspective. Qualitative data will be analysed using interpretative phenomenological analysis and framework analysis. ETHICS AND DISSEMINATION This protocol received ethical approval from London-Chelsea Research Ethics Committee (18/LO/0773). Findings will be published with open access licences. TRIAL REGISTRATION NUMBER ISRCTN15996256.
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Affiliation(s)
- Claudia S Estcourt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Fiona Mapp
- Institute for Global Health, UCL, London, UK
| | | | - Paul Flowers
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Tracy Roberts
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Sonali Wayal
- Institute for Global Health, UCL, London, UK
- Development Media International CIC, London, Greater London, UK
| | - Merle Symonds
- Western Sussex Hospitals NHS Foundation Trust, Worthing, West Sussex, UK
| | | | - John Saunders
- Institute for Global Health, UCL, London, UK
- Public Health England, London, UK
| | | | - Maria Pothoulaki
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christian Althaus
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Karen Pickering
- Health Economics Unit, University of Birmingham, Birmingham, UK
| | | | - Susannah Brice
- All East Sexual Health, Barts Health NHS Trust, London, UK
| | - Alex Comer
- All East Sexual Health, Barts Health NHS Trust, London, UK
| | | | | | - Gabriele Vojt
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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10
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Blomquist PB, Mohammed H, Mikhail A, Weatherburn P, Reid D, Wayal S, Hughes G, Mercer CH. Characteristics and sexual health service use of MSM engaging in chemsex: results from a large online survey in England. Sex Transm Infect 2020; 96:590-595. [PMID: 32139497 PMCID: PMC7677472 DOI: 10.1136/sextrans-2019-054345] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/24/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023] Open
Abstract
Background Chemsex, the use of select psychoactive drugs to enhance sexual experience, typically among men who have sex with men (MSM), is associated with sexual behaviours with higher STI risk. Understanding patterns of chemsex among MSM as well as the characteristics and sexual health service engagement of chemsex participants is important for developing interventions. Methods Between 5/2016 to 5/2017, 3933 MSM completed an online survey, recruited in sexual health clinics (SHCs) in England (n=421) and via four social networking/dating apps (n=3512). We described patterns of chemsex in the past year and used multivariable logistic regression to investigate differences in demographics and sexual behaviours by chemsex history. We described history of SHC attendance and STI test in the past year among app-recruited chemsex participants. Results Chemsex in the past year was reported by 10% of respondents; 19% of SHC-recruited and 9% of app-recruited. Among chemsex participants, 74% had used ≥2 chemsex drugs. In the multivariable model, MSM engaging in chemsex had a raised odds of being HIV-positive (adjusted OR (aOR): 3.6; 95% CI 2.1 to 6.1), aged 30–44 (aOR 1.5 vs <30 years; 95% CI 1.0 to 2.1), being born outside the UK and having engaged in higher risk sexual behaviours in the past 3 months. Chemsex participants also had higher odds of condomless anal sex with partners of different or unknown HIV status, but only among HIV-negative/untested. In the past year, 66% of app-recruited chemsex participants had attended a SHC and 81% had had an STI test. Conclusion One in 10 MSM recruited through community and clinical settings across England had engaged in chemsex in the past year. Those that did appear to be at greater STI risk but engaged more actively with sexual health services. This highlights the need and opportunity for chemsex-related services in SHCs and robust referral pathways to drug treatment services.
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Affiliation(s)
- Paula Bianca Blomquist
- UK Field Epidemiology Training Programme, Global Public Health Division, Public Health England, London, United Kingdom .,Field Service North West, National Infection Service, Public Health England, Liverpool, United Kingdom.,National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Hamish Mohammed
- Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom.,Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom
| | - Amy Mikhail
- UK Field Epidemiology Training Programme, Global Public Health Division, Public Health England, London, United Kingdom
| | - Peter Weatherburn
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Reid
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Sigma Research, Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom
| | - Gwenda Hughes
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, United Kingdom
| | - Catherine H Mercer
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at University College London in partnership with Public Health England (PHE), in collaboration with London School of Hygiene & Tropical Medicine, London, United Kingdom.,Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom
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11
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Daskalopoulou M, Rodger AJ, Phillips AN, Gilson R, Sherr L, Wayal S, Anderson J, Aderogba K, McDonnell J, Wilkins E, Youssef E, Speakman A, Burman WJ, Lampe FC. Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK. AIDS Care 2020; 32:1323-1332. [PMID: 32114800 DOI: 10.1080/09540121.2020.1728218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.
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Affiliation(s)
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | | | - Richard Gilson
- Institute for Global Health, University College London, London, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Jane Anderson
- Homerton University Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | - Andrew Speakman
- Institute for Global Health, University College London, London, UK
| | | | - Fiona C Lampe
- Institute for Global Health, University College London, London, UK
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12
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Harb AK, Mohammed H, Furegato M, Wayal S, Mercer CH, Hughes G. The association between region of birth and sexually transmitted infections among people of black Caribbean ethnicity attending sexual health services in England, 2015. PLoS One 2020; 15:e0228654. [PMID: 32084155 PMCID: PMC7034901 DOI: 10.1371/journal.pone.0228654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 01/21/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND/INTRODUCTION In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STIs), but it is unclear whether this varies by their region of birth. AIM(S)/OBJECTIVES To examine differences in STI diagnoses among UK- and Caribbean-born BC people. METHODS Data on STI diagnoses in BC people attending specialist sexual health services (SHSs) during 2015 and living in England were obtained from the GUMCAD STI surveillance system, the national surveillance system for STIs in England. Associations between being UK- or Caribbean-born and each of several STI diagnoses were examined, using univariate and multivariable generalised estimated equations logistic regression models adjusted for sexual orientation, place of residence (London vs. non-London), HIV status, area-level deprivation, and STI diagnosis in the last year. All analyses were stratified by age (<25 vs. ≥25 years). RESULTS In 2015, 63,568 BC people made 108,881 attendances at specialist SHSs; 81.9% of these attendances were made by UK-born BCs. The median age (years) was 26 for UK-born and 35 for Caribbean-born people (p≤0.001). Chlamydia, gonorrhoea and non-specific genital infection (NSGI) were the most commonly diagnosed STIs among UK- (5.8%, 2.1% and 2.8%) and Caribbean-born people (4.5%, 1.7% and 3.5%) respectively. Among BCs aged under 25, no significant differences in STIs were found between UK- and Caribbean-born people. Among BCs aged ≥25, compared to Caribbean-born people, those who were UK-born were more likely to be diagnosed with chlamydia (AOR 1.15 [95%C.I. 1.04-1.27]); gonorrhoea (AOR 1.23 [95%C.I. 1.06-1.45]) and genital herpes (AOR 1.23 [95% C.I. 1.10-1.56]) and less likely to be diagnosed with NSGI (AOR 0.89 [95% C.I. 0.80-0.99]) and Trichomoniasis (AOR 0.84 [95% C.I. 0.71-0.99]). DISCUSSION/CONCLUSION STI diagnoses in BC people aged ≥25 attending specialist SHSs vary by region of birth. Country of birth may have an influence on social and sexual networks and therefore transmission of STIs.
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Affiliation(s)
- Ana K. Harb
- National Infection Service, Public Health England, London, United Kingdom
- * E-mail:
| | - Hamish Mohammed
- National Infection Service, Public Health England, London, United Kingdom
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
| | - Martina Furegato
- National Infection Service, Public Health England, London, United Kingdom
- The Applied Diagnostic Research and Evaluation Unit (ADREU), St George’s, University, City, London, United Kingdom
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, University College London, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
| | - Gwenda Hughes
- National Infection Service, Public Health England, London, United Kingdom
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, United Kingdom
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13
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Wayal S, Gerressu M, Weatherburn P, Gilbart V, Hughes G, Mercer CH. A qualitative study of attitudes towards, typologies, and drivers of concurrent partnerships among people of black Caribbean ethnicity in England and their implications for STI prevention. BMC Public Health 2020; 20:188. [PMID: 32028917 PMCID: PMC7003336 DOI: 10.1186/s12889-020-8168-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/07/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Partner concurrency, (having sexual partnerships overlapping in time), especially when condoms are not used, can facilitate sexually transmitted infections (STI) transmission. In Britain, STI diagnoses rates and the reporting of concurrency are higher among black Caribbeans than other ethnic groups. We explored attitudes towards, drivers, characteristics, and contexts of concurrent partnerships, and their implications for STI risk among black Caribbeans in England. METHODS Purposive sampling, by sex and age-groups, was used to recruit participants (overall n = 59) from five sexual health clinics and community settings in London and Birmingham, England. Audio-recorded four focus group discussions (n = 28 participants), and in-depth interviews (n = 31) were conducted (June 2014-December 2015). Transcribed data were thematically analysed using Framework Analysis. RESULTS 'Main plus' and 'non-main' concurrency were identified in this population. Main plus concurrency involves an individual having a main partner with whom s/he has a "relationship" with, and the individual and/or their partner secretly or explicitly have other non-main partners. In contrast, non-main concurrency entails having multiple, non-committed partners overlapping in time, where concurrency is usually taken as a given, making disclosure to partners irrelevant. While main partnerships were usually long-term, non-main partnerships ranged in duration from a single event through to encounters lasting several months/years. Condomless sex was common with ex/long-term/married/cohabiting partners; whereas condoms were typically used with non-main partners. However, condom use declined with partnership duration and familiarity with partners. Awareness of partners' concurrency facilitated condom use, STI-testing, and partner notification. While unresolved feelings, or sharing children with ex-partners, usually facilitated main plus concurrency; non-main concurrency was common among young, and single people. Gender norms, notions of masculinity, and sexual desires influenced concurrency. Black Caribbean popular music, social media, peer pressure, and relationship norms among black Caribbeans were also perceived to encourage concurrency, especially among men and young people. CONCLUSIONS Concurrency among black Caribbeans is shaped by a complex interaction between emotional/psychological, interpersonal, sociocultural, and structural factors. Concurrency type, its duration, and awareness influence sexual health choices, and thus STI risk in this population. Collecting these data during clinic consultations could facilitate offering partner notification methods tailored to concurrency type. Gender- and age-specific, culturally-sensitive interventions addressing STI risks associated with concurrency are needed.
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Affiliation(s)
- Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, NW9 5EQ UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Peter Weatherburn
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Sigma Research, Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Victoria Gilbart
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, NW9 5EQ UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), London, WC1E 6JB UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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14
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Curtis TJ, Rodger AJ, Burns F, Nardone A, Copas A, Wayal S. Patterns of sexualised recreational drug use and its association with risk behaviours and sexual health outcomes in men who have sex with men in London, UK: a comparison of cross-sectional studies conducted in 2013 and 2016. Sex Transm Infect 2019; 96:197-203. [PMID: 31744928 PMCID: PMC7167300 DOI: 10.1136/sextrans-2019-054139] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/26/2019] [Accepted: 10/25/2019] [Indexed: 11/30/2022] Open
Abstract
Objective London has one of the highest identified prevalence of chemsex (sexualised recreational drug use) among men who have sex with men (MSM) in Europe. We examine MSM’s patterns of chemsex and its association with HIV/STI risk behaviours, STI diagnoses, and sexual healthcare-seeking behaviours, including if HIV testing behaviour met UK national guidelines (3-monthly if engaging in chemsex). Methods Cross-sectional survey data from 2013 (n=905) and 2016 (n=739) were collected using anonymous, self-administered questionnaires from MSM recruited in commercial gay venues in London, UK. Descriptive and multivariable analyses, stratified by self-reported HIV status, were conducted. Adjusted prevalence ratios (aPR) with 95% confidence intervals (CI) were calculated. Results Comparing the 2013 and 2016 surveys; chemsex prevalence in the past year remained stable, in both HIV-negative/unknown-status MSM (20.9% in 2013 vs 18.7% in 2016, p=0.301) and HIV-positive MSM (41.6% in 2013 vs 41.7% in 2016, p=0.992). Combined 2013-2016 data showed that compared to other MSM, those reporting chemsex were more likely to report HIV/STI risk behaviours, including condomless anal intercourse with serodifferent HIV-status partners (HIV-negative/unknown-status men: aPR 2.36, 95% CI 1.68-3.30; HIV-positive men: aPR 4.19, 95% CI 1.85-9.50), and STI diagnoses in the past year (HIV-negative/unknown-status men: aPR 2.10, 95% CI 1.64-2.69; HIV-positive men: aPR 2.56, 95% CI 1.57-4.20). 68.6% of HIV-negative/unknown-status men reporting chemsex attended sexual health clinics and 47.6% had tested for HIV more than once in the past year. Conclusions Chemsex in London MSM remained stable but high, particularly among HIV-positive men. Irrespective of HIV status, chemsex was associated with engagement in HIV/STI risk behaviours. Frequency of HIV testing in the past year among HIV-negative/unknown-status men was below national recommendations. Promoting combination prevention strategies, including 3-monthly HIV/STI testing, access to PrEP/ART, and behavioural interventions among MSM reporting chemsex, remain vital to address sexual health inequalities in MSM.
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Affiliation(s)
- Tyrone J Curtis
- Institute for Global Health, University College London, London, UK
| | - Alison J Rodger
- Institute for Global Health, University College London, London, UK
| | - Fiona Burns
- Institute for Global Health, University College London, London, UK
| | | | - Andrew Copas
- Institute for Global Health, University College London, London, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
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15
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Aicken CRH, Wayal S, Blomquist PB, Fabiane SM, Gerressu M, Hughes G, Mercer CH. Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys. BMC Health Serv Res 2019; 19:668. [PMID: 31533716 PMCID: PMC6749649 DOI: 10.1186/s12913-019-4396-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/01/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.
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Affiliation(s)
- Catherine R. H. Aicken
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- School of Health Sciences, University of Brighton, Village Way, Falmer, Brighton, BN1 9PH UK
| | - Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Stella M. Fabiane
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Makeda Gerressu
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control, Public Health England (PHE), 61 Colindale Ave, London, NW9 5EQ UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
- Instituto de Medicina Tropical, Universidade de São Paulo, São Paulo, Brazil
| | - Catherine H. Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London (UCL), Mortimer Market Centre, London, WC1E 6JB UK
- National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL, in partnership with PHE, and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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Aicken CR, Wayal S, Blomquist P, Fabiane S, Gerressu M, Hughes G, Mercer CH. Ethnic variations in sexual partnerships and mixing, and their association with STI diagnosis: findings from a cross-sectional biobehavioural survey of attendees of sexual health clinics across England. Sex Transm Infect 2019; 96:283-292. [PMID: 31422350 PMCID: PMC7279208 DOI: 10.1136/sextrans-2018-053739] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 05/14/2019] [Accepted: 07/13/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Ethnic differences in partnership types and sexual mixing patterns may contribute to elevated STI diagnosis rates among England's Black Caribbean (BC) population. We examined the differences between BC and White British/Irish (WBI) sexual health clinic (SHC) attendees' reported partnerships and sexual mixing, and whether these differences could explain ethnic inequalities in STI, focusing on attendees reporting only opposite-sex partners (past year). METHODS We surveyed attendees at 16 SHCs across England (May to September 2016), and linked their survey responses to routinely collected data on diagnoses of bacterial STI or trichomoniasis ±6 weeks of clinic attendance ('acute STI'). Behaviourally-heterosexual BC and WBI attendees (n=1790) reported details about their ≤3 most recent opposite-sex partners (past 3 months, n=2503). We compared BC and WBI attendees' reported partnerships and mixing, in gender-stratified analyses, and used multivariable logistic regression to examine whether they independently explained differences in acute STI. RESULTS We observed differences by ethnic group. BC women's partnerships were more likely than WBI women's partnerships to involve age-mixing (≥5 years age difference; 31.6% vs 25.5% partnerships, p=0.013); BC men's partnerships were more often 'uncommitted regular' (35.4% vs 20.7%) and less often casual (38.5% vs 53.1%) than WBI men's partnerships (p<0.001). Acute STI was higher among BC women than WBI women (OR: 2.29, 95% CI 1.24 to 4.21), with no difference among men. This difference was unaffected by partnerships and mixing: BC women compared with WBI women adjusted OR: 2.31 (95% CI 1.30 to 4.09) after adjusting for age and partner numbers; 2.15 (95% CI 1.07 to 4.31) after additionally adjusting for age-mixing, ethnic-mixing and recent partnership type(s). CONCLUSION We found that differences in sexual partnerships and mixing do not appear to explain elevated risk of acute STI diagnosis among behaviourally-heterosexual BC women SHC attendees, but this may reflect the measures used. Better characterisation of 'high transmission networks' is needed, to improve our understanding of influences beyond the individual level, as part of endeavours to reduce population-level STI transmission.
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Affiliation(s)
- Catherine Rh Aicken
- Institute for Global Health, University College London, London, UK .,School of Health Sciences, University of Brighton, Brighton, UK
| | - Sonali Wayal
- Institute for Global Health, University College London, London, UK
| | - Paula Blomquist
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Stella Fabiane
- Institute for Global Health, University College London, London, UK.,MRC Clinical Trials Unit, University College London, London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London, London, UK.,Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
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Wayal S, Reid D, Weatherburn P, Blomquist P, Fabiane S, Hughes G, Mercer CH. Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom. HIV Med 2019; 20:523-533. [PMID: 31124278 PMCID: PMC6771985 DOI: 10.1111/hiv.12753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
Objectives In the UK, men who have sex with men (MSM) bear a disproportionate sexually transmitted infection (STI) burden. We investigated MSM's STI knowledge; whether their STI testing behaviour met national guidelines (annually if sexually active; 3‐monthly if engaging in STI risk behaviours); and the relationship between STI testing in the last 3 months, STI knowledge and STI risk behaviours by HIV status. Methods Sexually active (in the last year) men aged > 15 years who were UK residents and were recruited from gay‐orientated online dating platforms completed an anonymous online survey about STI knowledge, STI risk behaviours, and STI testing (March–May 2017). This included 11 true statements about STIs. Respondents scored 1 for each statement they ‘knew’, with those scoring < 6 overall treated as having ‘poor’ STI knowledge. Descriptive and multivariable analyses were conducted, separately by HIV status, to test our hypothesis and calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results Compared to HIV‐positive men (n = 489), the proportion of HIV‐negative/unknown‐status men (n = 3157) with ‘poor’ STI knowledge was significantly higher (46.4% versus 22.9% for HIV‐positive men) and the proportion with STI testing in the last 12 months was lower (71.6% versus 87.2%, respectively). In the last 3 months, 56.9% of HIV‐negative/unknown‐status and 74.1% of HIV‐positive men reported STI risk behaviours, of whom 45.8% and 55.1%, respectively, had been tested for STIs during this time. Among HIV‐negative/unknown‐status men, those reporting STI risk behaviours were more likely (AOR 1.52; 95% CI 1.26–1.84) and those with poor STI knowledge less likely (AOR 0.73; 95% CI 0.61–0.89) to have been tested during the last 3 months. However, neither factor was independently associated with 3‐monthly testing among HIV‐positive men. Conclusions Improving STI knowledge, especially among HIV‐negative/unknown‐status men, and promoting frequent STI testing among men engaging in STI risk behaviours are vital to address the poor sexual health of MSM.
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Affiliation(s)
- S Wayal
- Institute for Global Health, University College London, London, UK.,HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - D Reid
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - P Weatherburn
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - P Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - S Fabiane
- Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - G Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - C H Mercer
- Institute for Global Health, University College London, London, UK.,The National Institute for Health Research Health Protection Research Unit (NIHR HPRU), in Blood Borne and Sexually Transmitted Infections, UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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18
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McDonagh LK, Blomquist P, Wayal S, Cochrane S, Calliste J, Cassell JA, Edelman NL. Collaborative and consultative patient and public involvement in sexual health research: lessons learnt from four case studies. Sex Transm Infect 2019; 96:96-100. [PMID: 31073093 DOI: 10.1136/sextrans-2018-053922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/14/2019] [Accepted: 03/25/2019] [Indexed: 11/04/2022] Open
Affiliation(s)
- Lorraine K McDonagh
- Research Department of Primary Care and Population Health, University College London, London, UK .,National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine, London, UK
| | - Paula Blomquist
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine, London, UK.,Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Division, Public Health England, London, UK
| | - Sonali Wayal
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine, London, UK.,Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, UK
| | - Sarah Cochrane
- Unity Sexual Health, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Josina Calliste
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine, London, UK
| | - Jackie A Cassell
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, in partnership with Public Health England and in collaboration with London School of Hygiene and Tropical Medicine, London, UK.,Departmentof Primary Care and Public Health, Brighton and Sussex Medical School, Universityof Brighton, Brighton, UK
| | - Natalie Lois Edelman
- Centre for Health Research, School of Health Sciences, University of Brighton, Brighton, UK
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19
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Seguin M, Dodds C, Mugweni E, McDaid L, Flowers P, Wayal S, Zomer E, Weatherburn P, Fakoya I, Hartney T, McDonagh L, Hunter R, Young I, Khan S, Freemantle N, Chwaula J, Sachikonye M, Anderson J, Singh S, Nastouli E, Rait G, Burns F. Self-sampling kits to increase HIV testing among black Africans in the UK: the HAUS mixed-methods study. Health Technol Assess 2019; 22:1-158. [PMID: 29717978 DOI: 10.3310/hta22220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Timely diagnosis of human immunodeficiency virus (HIV) enables access to antiretroviral treatment, which reduces mortality, morbidity and further transmission in people living with HIV. In the UK, late diagnosis among black African people persists. Novel methods to enhance HIV testing in this population are needed. OBJECTIVES To develop a self-sampling kit (SSK) intervention to increase HIV testing among black Africans, using existing community and health-care settings (stage 1) and to assess the feasibility for a Phase III evaluation (stage 2). DESIGN A two-stage, mixed-methods design. Stage 1 involved a systematic literature review, focus groups and interviews with key stakeholders and black Africans. Data obtained provided the theoretical base for intervention development and operationalisation. Stage 2 was a prospective, non-randomised study of a provider-initiated, HIV SSK distribution intervention targeted at black Africans. The intervention was assessed for cost-effectiveness. A process evaluation explored feasibility, acceptability and fidelity. SETTING Twelve general practices and three community settings in London. MAIN OUTCOME MEASURE HIV SSK return rate. RESULTS Stage 1 - the systematic review revealed support for HIV SSKs, but with scant evidence on their use and clinical effectiveness among black Africans. Although the qualitative findings supported SSK distribution in settings already used by black Africans, concerns were raised about the complexity of the SSK and the acceptability of targeting. These findings were used to develop a theoretically informed intervention. Stage 2 - of the 349 eligible people approached, 125 (35.8%) agreed to participate. Data from 119 were included in the analysis; 54.5% (65/119) of those who took a kit returned a sample; 83.1% of tests returned were HIV negative; and 16.9% were not processed, because of insufficient samples. Process evaluation showed the time pressures of the research process to be a significant barrier to feasibility. Other major barriers were difficulties with the SSK itself and ethnic targeting in general practice settings. The convenience and privacy associated with the SSK were described as beneficial aspects, and those who used the kit mostly found the intervention to be acceptable. Research governance delays prevented implementation in Glasgow. LIMITATIONS Owing to the study failing to recruit adequate numbers (the intended sample was 1200 participants), we were unable to evaluate the clinical effectiveness of SSKs in increasing HIV testing in black African people. No samples were reactive, so we were unable to assess pathways to confirmatory testing and linkage to care. CONCLUSIONS Our findings indicate that, although aspects of the intervention were acceptable, ethnic targeting and the SSK itself were problematic, and scale-up of the intervention to a Phase III trial was not feasible. The preliminary economic model suggests that, for the acceptance rate and test return seen in the trial, the SSK is potentially a cost-effective way to identify new infections of HIV. FUTURE WORK Sexual and public health services are increasingly utilising self-sampling technologies. However, alternative, user-friendly SSKs that meet user and provider preferences and UK regulatory requirements are needed, and additional research is required to understand clinical effectiveness and cost-effectiveness for black African communities. STUDY REGISTRATION This study is registered as PROSPERO CRD42014010698 and Integrated Research Application System project identification 184223. FUNDING The National Institute for Health Research Health Technology Assessment programme and the BHA for Equality in Health and Social Care.
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Affiliation(s)
- Maureen Seguin
- Research Department, Infection & Population Health, University College London, London, UK
| | - Catherine Dodds
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Esther Mugweni
- Research Department, Infection & Population Health, University College London, London, UK
| | - Lisa McDaid
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Paul Flowers
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sonali Wayal
- Research Department, Infection & Population Health, University College London, London, UK
| | - Ella Zomer
- Research Department, Primary Care and Population Health, University College London, London, UK
| | - Peter Weatherburn
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Ibidun Fakoya
- Research Department, Infection & Population Health, University College London, London, UK
| | - Thomas Hartney
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Lorraine McDonagh
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK
| | - Rachael Hunter
- Research Department, Primary Care and Population Health, University College London, London, UK
| | - Ingrid Young
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Shabana Khan
- PRIMENT Clinical Trials Unit, Primary Care and Population Health, University College London, London, UK
| | - Nick Freemantle
- PRIMENT Clinical Trials Unit, Primary Care and Population Health, University College London, London, UK
| | | | | | - Jane Anderson
- Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, London, UK
| | - Surinder Singh
- Research Department, Primary Care and Population Health, University College London, London, UK
| | - Eleni Nastouli
- Virology Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Greta Rait
- National Institute for Health Research Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London, London, UK.,PRIMENT Clinical Trials Unit, Primary Care and Population Health, University College London, London, UK
| | - Fiona Burns
- Research Department, Infection & Population Health, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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20
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Datta J, Reid D, Hughes G, Mercer CH, Wayal S, Weatherburn P. Awareness of and attitudes to sexually transmissible infections among gay men and other men who have sex with men in England: a qualitative study. Sex Health 2019; 16:18-24. [DOI: 10.1071/sh18025] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/23/2018] [Indexed: 11/23/2022]
Abstract
Background
Rates of sexually transmissible infections (STIs) have increased over recent years among gay men and other men who have sex with men (MSM) in England and Wales. HIV diagnoses remain high in this group and men with diagnosed HIV are disproportionally affected by STIs. MSM are therefore a priority for health promotion efforts to reduce STIs. Understanding awareness of and attitudes towards STIs is essential in developing health promotion interventions to reduce prevalence. Methods: Eight focus group discussions (FGDs) with a total of 61 MSM in four English cities included a ranking exercise to gauge how ‘scary’ participants thought 11 STIs are. The exercise sought insights into participants’ awareness of, knowledge about and attitudes towards STIs and blood-borne viruses (BBVs). FGDs were audio-recorded, transcribed and data analysed thematically. Results: All groups ranked HIV and Hepatitis C virus (HCV) as the scariest infections, and the majority ranked syphilis and herpes as highly scary. Scabies was ranked as the least scary by most groups. Rankings were dependent on how well informed participants felt about an infection, its transmission mechanisms, health affect and the availability of vaccines and treatment. Personal experience or that of friends influenced perceptions of particular infections, as did their prevalence, treatment options, visibility of symptoms and whether an STI could be cleared from the body. Conclusions: The study findings suggest that, although some MSM are well informed, there is widespread lack of knowledge about the prevalence, modes of transmission, health implications and treatment regimens of particular STIs.
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21
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Wayal S, Aicken CRH, Griffiths C, Blomquist PB, Hughes G, Mercer CH. Understanding the burden of bacterial sexually transmitted infections and Trichomonas vaginalis among black Caribbeans in the United Kingdom: Findings from a systematic review. PLoS One 2018; 13:e0208315. [PMID: 30532145 PMCID: PMC6285827 DOI: 10.1371/journal.pone.0208315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 11/14/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the UK, people of black Caribbean (BC) ethnicity continue to be disproportionately affected by bacterial sexually transmitted infections (STIs) and Trichomonas vaginalis (TV). We systematically reviewed evidence on the association between bacterial STIs/TV and ethnicity (BC compared to white/white British (WB)) accounting for other risk factors; and differences between these two ethnic groups in the prevalence of risk factors associated with these STIs, sexual healthcare seeking behaviours, and contextual factors influencing STI risk. METHODS Studies presenting relevant evidence for participants aged ≥14 years and living in the UK were eligible for inclusion. A pre-defined search strategy informed by the inclusion criteria was developed. Eleven electronic databases were searched from the start date to September-October 2016. Two researchers independently screened articles, extracted data using a standardised proforma and resolved discrepancies in discussion with a third researcher. Descriptive summaries of evidence are presented. Meta-analyses were not conducted due to variation in study designs. Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed. RESULTS Of 3815 abstracts identified, 15 articles reporting quantitative data were eligible and included in the review. No qualitative studies examining contextual drivers of STI risk among people of BC ethnicity were identified. Compared to the white/WB ethnic group, the greater STI/TV risk among BCs was partially explained by variations in socio-demographic factors, sexual behaviours, and recreational drug use. The prevalence of reporting early sexual debut (<16 years), concurrency, and multiple partners was higher among BC men compared to white/WB men; however, no such differences were observed for women. People of BC ethnicity were more likely to access sexual health services than those of white/WB ethnicity. CONCLUSIONS Further research is needed to explore other drivers of the sustained higher STI/TV prevalence among people of BC ethnicity. Developing holistic, tailored interventions that address STI risk and target people of BC ethnicity, especially men, could enhance STI prevention.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London, London, United Kingdom
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Catherine R. H. Aicken
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine Griffiths
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula B. Blomquist
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- HIV & STI Department, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine H. Mercer
- Institute for Global Health, University College London, London, United Kingdom
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, United Kingdom
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22
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Dodds C, Mugweni E, Phillips G, Park C, Young I, Fakoya I, Wayal S, McDaid L, Sachikonye M, Chwaula J, Flowers P, Burns F. Correction to: Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study. BMC Public Health 2018; 18:866. [PMID: 30001193 PMCID: PMC6043976 DOI: 10.1186/s12889-018-5775-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 11/10/2022] Open
Abstract
It has been highlighted that in the original article [1] there is a typesetting mistake in the name of I. Fakoya. This was incorrectly captured as F. Fakoya. This correction article clarifies the correct name of the author.
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Affiliation(s)
- C Dodds
- London School of Hygiene and Tropical Medicine, London, UK. .,University of Glasgow, Glasgow, UK.
| | - E Mugweni
- University College London, London, UK
| | - G Phillips
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - C Park
- University of Glasgow, Glasgow, UK
| | - I Young
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - I Fakoya
- University College London, London, UK
| | - S Wayal
- University College London, London, UK
| | - L McDaid
- University of Glasgow, Glasgow, UK
| | - M Sachikonye
- UK Community Advisory Board for HIV and iBase, London, UK
| | | | - P Flowers
- Glasgow Caledonian University, Glasgow, UK
| | - F Burns
- University College London, London, UK
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23
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Wayal S, Reid D, Blomquist PB, Weatherburn P, Mercer CH, Hughes G. The Acceptability and Feasibility of Implementing a Bio-Behavioral Enhanced Surveillance Tool for Sexually Transmitted Infections in England: Mixed-Methods Study. JMIR Public Health Surveill 2018; 4:e52. [PMID: 29728348 PMCID: PMC5960042 DOI: 10.2196/publichealth.9010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/19/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Sexually transmitted infection (STI) surveillance is vital for tracking the scale and pattern of epidemics; however, it often lacks data on the underlying drivers of STIs. OBJECTIVE This study aimed to assess the acceptability and feasibility of implementing a bio-behavioral enhanced surveillance tool, comprising a self-administered Web-based survey among sexual health clinic attendees, as well as linking this to their electronic health records (EHR) held in England's national STI surveillance system. METHODS Staff from 19 purposively selected sexual health clinics across England and men who have sex with men and black Caribbeans, because of high STI burden among these groups, were interviewed to assess the acceptability of the proposed bio-behavioral enhanced surveillance tool. Subsequently, sexual health clinic staff invited all attendees to complete a Web-based survey on drivers of STI risk using a study tablet or participants' own digital device. They recorded the number of attendees invited and participants' clinic numbers, which were used to link survey data to the EHR. Participants' online consent was obtained, separately for survey participation and linkage. In postimplementation phase, sexual health clinic staff were reinterviewed to assess the feasibility of implementing the bio-behavioral enhanced surveillance tool. Acceptability and feasibility of implementing the bio-behavioral enhanced surveillance tool were assessed by analyzing these qualitative and quantitative data. RESULTS Prior to implementation of the bio-behavioral enhanced surveillance tool, sexual health clinic staff and attendees emphasized the importance of free internet/Wi-Fi access, confidentiality, and anonymity for increasing the acceptability of the bio-behavioral enhanced surveillance tool among attendees. Implementation of the bio-behavioral enhanced surveillance tool across sexual health clinics varied considerably and was influenced by sexual health clinics' culture of prioritization of research and innovation and availability of resources for implementing the surveys. Of the 7367 attendees invited, 85.28% (6283) agreed to participate. Of these, 72.97% (4585/6283) consented to participate in the survey, and 70.62% (4437/6283) were eligible and completed it. Of these, 91.19% (4046/4437) consented to EHR linkage, which did not differ by age or gender but was higher among gay/bisexual men than heterosexual men (95.50%, 722/756 vs 88.31%, 1073/1215; P<.003) and lower among black Caribbeans than white participants (87.25%, 568/651 vs 93.89%, 2181/2323; P<.002). Linkage was achieved for 88.88% (3596/4046) of consenting participants. CONCLUSIONS Implementing a bio-behavioral enhanced surveillance tool in sexual health clinics was feasible and acceptable to staff and groups at STI risk; however, ensuring participants' confidentiality and anonymity and availability of resources is vital. Bio-behavioral enhanced surveillance tools could enable timely collection of detailed behavioral data for effective commissioning of sexual health services.
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Affiliation(s)
- Sonali Wayal
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom.,Centre for Infectious Disease Surveillance and Control, HIV & STI Department, Public Health England, London, United Kingdom.,The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - David Reid
- Centre for Infectious Disease Surveillance and Control, HIV & STI Department, Public Health England, London, United Kingdom.,The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Paula B Blomquist
- Centre for Infectious Disease Surveillance and Control, HIV & STI Department, Public Health England, London, United Kingdom.,The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Peter Weatherburn
- The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom.,Sigma Research, Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Catherine H Mercer
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom.,The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Gwenda Hughes
- Centre for Population Research in Sexual Health and HIV, Institute for Global Health, University College London, London, United Kingdom.,Centre for Infectious Disease Surveillance and Control, HIV & STI Department, Public Health England, London, United Kingdom.,The National Institute for Health Research, Health Protection Research Unit in Blood Borne and Sexually Transmitted Infections, University College London / Public Health England / London School of Hygiene & Tropical Medicine, London, United Kingdom
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Dodds C, Mugweni E, Phillips G, Park C, Young I, Fakoya I, Wayal S, McDaid L, Sachikonye M, Chwaula J, Flowers P, Burns F. Acceptability of HIV self-sampling kits (TINY vial) among people of black African ethnicity in the UK: a qualitative study. BMC Public Health 2018; 18:499. [PMID: 29653536 PMCID: PMC5899406 DOI: 10.1186/s12889-018-5256-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 03/06/2018] [Indexed: 12/02/2022] Open
Abstract
Background Increasing routine HIV testing among key populations is a public health imperative, so improving access to acceptable testing options for those in need is a priority. Despite increasing targeted distribution and uptake of HIV self-sampling kits (SSKs) among men who have sex with men in the UK, little is known about why targeted SSK interventions for black African users are not as wide-spread or well-used. This paper addresses this key gap, offering insight into why some groups may be less likely than others to adopt certain types of SSK interventions in particular contexts. These data were collected during the development phase of a larger study to explore the feasibility and acceptability of targeted distribution of SSKs to black African people. Methods We undertook 6 focus groups with members of the public who self-identified as black African (n = 48), 6 groups with specialists providing HIV and social services to black African people (n = 53), and interviews with HIV specialist consultants and policy-makers (n = 9). Framework analysis was undertaken, using inductive and deductive analysis to develop and check themes. Results We found three valuable components of targeted SSK interventions for this population: the use of settings and technologies that increase choice and autonomy; targeted offers of HIV testing that preserve privacy and do not exacerbate HIV stigma; and ensuring that the specific kit being used (in this case, the TINY vial) is perceived as simple and reliable. Conclusions This unique and rigorous research offers insights into participants’ views on SSK interventions, offering key considerations when targeting this population.. Given the plethora of HIV testing options, our work demonstrates that those commissioning and delivering SSK interventions will need to clarify (for users and providers) how each kit type and intervention design adds value. Most significantly, these findings demonstrate that without a strong locus of control over their own circumstances and personal information, black African people are less likely to feel that they can pursue an HIV test that is safe and secure. Thus, where profound social inequalities persist, so will inequalities in HIV testing uptake – by any means. Electronic supplementary material The online version of this article (10.1186/s12889-018-5256-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Dodds
- London School of Hygiene and Tropical Medicine, London, UK. .,University of Glasgow, Glasgow, UK.
| | - E Mugweni
- University College London, London, UK
| | - G Phillips
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - C Park
- University of Glasgow, Glasgow, UK
| | - I Young
- University of Glasgow, Glasgow, UK.,University of Edinburgh, Edinburgh, UK
| | - I Fakoya
- University College London, London, UK
| | - S Wayal
- University College London, London, UK
| | - L McDaid
- University of Glasgow, Glasgow, UK
| | - M Sachikonye
- UK Community Advisory Board for HIV and iBase, London, UK
| | | | - P Flowers
- Glasgow Caledonian University, Glasgow, UK
| | - F Burns
- University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
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25
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Wayal S, Hughes G, Sonnenberg P, Mohammed H, Copas AJ, Gerressu M, Tanton C, Furegato M, Mercer CH. Ethnic variations in sexual behaviours and sexual health markers: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). Lancet Public Health 2017; 2:e458-e472. [PMID: 29057382 PMCID: PMC5639148 DOI: 10.1016/s2468-2667(17)30159-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sexual health entails the absence of disease and the ability to lead a pleasurable and safe sex life. In Britain, ethnic inequalities in diagnoses of sexually transmitted infections (STI) persist; however, the reasons for these inequalities, and ethnic variations in other markers of sexual health, remain poorly understood. We investigated ethnic differences in hypothesised explanatory factors such as socioeconomic factors, substance use, depression, and sexual behaviours, and whether they explained ethnic variations in sexual health markers (reported STI diagnoses, attendance at sexual health clinics, use of emergency contraception, and sexual function). METHODS We analysed probability survey data from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3; n=15 162, conducted in 2010-12). Reflecting Britain's current ethnic composition, we included in our analysis participants who identified in 2011 as belonging to one of the following seven largest ethnic groups: white British, black Caribbean, black African, Indian, Pakistani, white other, and mixed ethnicity. We calculated age-standardised estimates and age-adjusted odds ratios for all explanatory factors and sexual health markers for all these ethnic groups with white British as the reference category. We used multivariable regression to examine the extent to which adjusting for explanatory factors explained ethnic variations in sexual health markers. FINDINGS We included 14 563 (96·0%) of the 15 162 participants surveyed in Natsal-3. Greater proportions of black Caribbean, black African, and Pakistani people lived in deprived areas than those of other ethnic groups (36·9-55·3% vs 16·4-29·4%). Recreational drug use was highest among white other and mixed ethnicity groups (25·6-27·7% in men and 10·3-12·9% in women in the white other and mixed ethnicity groups vs 4·1-15·6% in men and 1·0-11·2% in women of other ethnicities). Compared with white British men, the proportions of black Caribbean and black African men reporting being sexually competent at sexual debut were lower (32·9% for black Caribbean and 21·9% for black African vs 47·4% for white British) and the number of partners in the past 5 years was greater (median 2 [IQR 1-4] for black Caribbean and 2 [1-5] for black African vs 1 [1-2] for white British), and although black Caribbean and black African men reported greater proportions of concurrent partnerships (26·5% for black Caribbean and 38·9% for black African vs 14·8% for white British), these differences were not significant after adjusting for age. Compared with white British women, the proportions of black African and mixed ethnicity women reporting being sexually competent were lower (18·0% for black African and 35·3% for mixed ethnicity vs 47·9% for white British), and mixed ethnicity women reported larger numbers of partners in the past 5 years (median 1 [IQR 1-4] vs 1 [1-2]) and greater concurrency (14·3% vs 8·0%). Reporting STI diagnoses was higher in black Caribbean men (8·7%) and mixed ethnicity women (6·7%) than white British participants (3·6% in men and 3·2% in women). Use of emergency contraception was most commonly reported among black Caribbean women (30·7%). Low sexual function was most common among women of white other ethnicity (30·1%). Adjustment for explanatory factors only partly explained inequalities among some ethnic groups relative to white British ethnicity but did not eliminate ethnic differences in these markers. INTERPRETATION Ethnic inequalities in sexual health markers exist, and they were not fully explained by differences in their broader determinants. Holistic interventions addressing modifiable risk factors and targeting ethnic groups at risk of poor sexual health are needed. FUNDING Medical Research Council, the Wellcome Trust, the Economic and Social Research Council, UK Department of Health, and The National Institute for Health Research.
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Affiliation(s)
- Sonali Wayal
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
| | - Pam Sonnenberg
- Institute for Global Health, University College London (UCL), London, UK
| | - Hamish Mohammed
- Institute for Global Health, University College London (UCL), London, UK
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Andrew J Copas
- Institute for Global Health, University College London (UCL), London, UK
| | - Makeda Gerressu
- Institute for Global Health, University College London (UCL), London, UK
| | - Clare Tanton
- Institute for Global Health, University College London (UCL), London, UK
| | - Martina Furegato
- HIV & STI Department, Public Health England, Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK
| | - Catherine H Mercer
- Institute for Global Health, University College London (UCL), London, UK
- The National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Blood Borne and Sexually Transmitted Infections at UCL in partnership with Public Health England (PHE) and in collaboration with the London School of Hygiene & Tropical Medicine, London, UK
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26
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Datta J, Reid D, Hughes G, Mercer CH, Wayal S, Weatherburn P. Places and people: the perceptions of men who have sex with men concerning STI testing: a qualitative study. Sex Transm Infect 2017; 94:46-50. [PMID: 28778980 PMCID: PMC5800331 DOI: 10.1136/sextrans-2016-052983] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 06/26/2017] [Accepted: 07/02/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives To explore the experiences and views of men who have sex with men (MSM) on attending clinical sexual health services and their preferences regarding service characteristics in the context of the disproportionate burden of STIs experienced by this group. The wider study aim was to develop a risk assessment tool for use in sexual health clinics. Methods Qualitative study comprising eight focus group discussions with 61 MSM in four English cities. Topics included: experience of attending sexual health services, perceptions of norms of attendance among MSM, knowledge of, and attitudes towards, STIs and views on ‘being researched.’ Discussions were audio-recorded and transcribed and a thematic data analysis conducted. Results Attending sexual health services for STI testing was described as embarrassing by some and some clinic procedures were thought to compromise confidentiality. Young men seeking STI testing were particularly sensitive to feelings of awkwardness and self-consciousness. Black and ethnic minority men were concerned about being exposed in their communities. The personal qualities of staff were seen as key features of sexual health services. Participants wanted staff to be friendly, professional, discreet, knowledgeable and non-judgemental. Conclusions A range of opinion on the type of STI service men preferred was expressed with some favouring generic sexual and reproductive health clinics and others favouring specialist community-based services. There was consensus on the qualities they would like to see in healthcare staff. The knowledge, conduct and demeanour of staff could exacerbate or ameliorate unease associated with attending for STI testing.
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Affiliation(s)
- Jessica Datta
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - David Reid
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Gwenda Hughes
- Centre for Infectious Disease Surveillance and Control, Public Health England, London, UK
| | - Catherine H Mercer
- Department of Infection and Population Health, University College London, London, UK
| | - Sonali Wayal
- Department of Infection and Population Health, University College London, London, UK
| | - Peter Weatherburn
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
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Gafos M, Brodnicki E, Desai M, McCormack S, Nutland W, Wayal S, White E, Wood G, Barber T, Bell G, Clarke A, Dolling D, Dunn D, Fox J, Haddow L, Lacey C, Nardone A, Quinn K, Rae C, Reeves I, Rayment M, White D, Apea V, Ayap W, Dewsnap C, Collaco-Moraes Y, Schembri G, Sowunmi Y, Horne R. Acceptability of an open-label wait-listed trial design: Experiences from the PROUD PrEP study. PLoS One 2017; 12:e0175596. [PMID: 28426834 PMCID: PMC5398545 DOI: 10.1371/journal.pone.0175596] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 03/28/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND PROUD participants were randomly assigned to receive pre-exposure prophylaxis (PrEP) immediately or after a deferred period of one-year. We report on the acceptability of this open-label wait-listed trial design. METHODS Participants completed an acceptability questionnaire, which included categorical study acceptability data and free-text data on most and least liked aspects of the study. We also conducted in-depth interviews (IDI) with a purposely selected sub-sample of participants. RESULTS Acceptability questionnaires were completed by 76% (415/544) of participants. After controlling for age, immediate-group participants were almost twice as likely as deferred-group participants to complete the questionnaire (AOR:1.86;95%CI:1.24,2.81). In quantitative data, the majority of participants in both groups found the wait-listed design acceptable when measured by satisfaction of joining the study, intention to remain in the study, and interest in joining a subsequent study. However, three-quarters thought that the chance of being in the deferred-group might put other volunteers off joining the study. In free-text responses, data collection tools were the most frequently reported least liked aspect of the study. A fifth of deferred participants reported 'being deferred' as the thing they least liked about the study. However, more deferred participants disliked the data collection tools than the fact that they had to wait a year to access PrEP. Participants in the IDIs had a good understanding of the rationale for the open-label wait-listed study design. Most accepted the design but acknowledged they were, or would have been, disappointed to be randomised to the deferred group. Five of the 25 participants interviewed reported some objection to the wait-listed design. CONCLUSION The quantitative and qualitative findings suggest that in an environment where PrEP was not available, the rationale for the wait-listed trial design was well understood and generally acceptable to most participants in this study.
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Affiliation(s)
- Mitzy Gafos
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Elizabeth Brodnicki
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Monica Desai
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Sheena McCormack
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Will Nutland
- Sigma research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
| | - Ellen White
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gemma Wood
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Tristan Barber
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Gill Bell
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Amanda Clarke
- Claude Nichol Centre, Royal Sussex County Hospital, Brighton, United Kingdom
| | - David Dolling
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - David Dunn
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Julie Fox
- Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Lewis Haddow
- Centre for Sexual Health and HIV Research, Mortimer Market Centre, London, United Kingdom
- Research Department of Infection and Population Health, University College London, London, United Kingdom
| | - Charles Lacey
- York Hospitals NHS Foundation Trust, York, United Kingdom
| | - Anthony Nardone
- HIV/STI Department, Public Health England, London, United Kingdom
| | - Killian Quinn
- King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Caroline Rae
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Iain Reeves
- Department of Sexual Health, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Michael Rayment
- Directorate of HIV and GU medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - David White
- Heart of England NHS Foundation Trust, Birmingham, United Kingdom
| | - Vanessa Apea
- Ambrose King Centre, Barts Health NHS Trust, London, United Kingdom
| | - Wilbert Ayap
- St Mary’s Hospital, Imperial College NHS Foundation Trust, London, United Kingdom
| | - Claire Dewsnap
- Sheffield Health, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Yolanda Collaco-Moraes
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Gabriel Schembri
- Manchester Centre for Sexual Health, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Yinka Sowunmi
- Medical Research Council Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, United Kingdom
| | - Rob Horne
- School of Pharmacy, University College London, London, United Kingdom
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28
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Aghaizu A, Wayal S, Nardone A, Parsons V, Copas A, Mercey D, Hart G, Gilson R, Johnson AM. Sexual behaviours, HIV testing, and the proportion of men at risk of transmitting and acquiring HIV in London, UK, 2000-13: a serial cross-sectional study. Lancet HIV 2016; 3:e431-e440. [PMID: 27562744 DOI: 10.1016/s2352-3018(16)30037-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND HIV incidence in men who have sex with men (MSM) in the UK has remained unchanged over the past decade despite increases in HIV testing and antiretroviral therapy (ART) coverage. In this study, we examine trends in sexual behaviours and HIV testing in MSM and explore the risk of transmitting and acquiring HIV. METHODS In this serial cross-sectional study, we obtained data from ten cross-sectional surveys done between 2000 and 2013, consisting of anonymous self-administered questionnaires and oral HIV antibody testing in MSM recruited in gay social venues in London, UK. Data were collected between October and January for all survey years up to 2008 and between February and August thereafter. All men older than 16 years were eligible to take part and fieldworkers attempted to approach all MSM in each venue and recorded refusal rates. Data were collected on demographic and sexual behavioural characteristics. We analysed trends over time using linear, logistic, and quantile regression. FINDINGS Of 13 861 questionnaires collected between 2000 and 2013, we excluded 1985 (124 had completed the survey previously or were heterosexual reporting no anal intercourse in the past year, and 1861 did not provide samples for antibody testing). Of the 11 876 eligible MSM recruited, 1512 (13%) were HIV positive, with no significant trend in HIV positivity over time. 35% (531 of 1505) of HIV-positive MSM had undiagnosed infection, which decreased non-linearly over time from 34% (45 of 131) to 24% (25 of 106; p=0·01), while recent HIV testing (ie, in the past year) increased from 26% (263 of 997) to 60% (467 of 777; p<0·0001). The increase in recent testing in undiagnosed men (from 29% to 67%, p<0·0001) and HIV-negative men (from 26% to 62%, p<0·0001) suggests that undiagnosed infection might increasingly be recently acquired infection. The proportion of MSM reporting unprotected anal intercourse (UAI) in the past year increased from 43% (513 of 1187) to 53% (394 of 749; p<0·0001) and serosorting (exclusively) increased from 18% (207 of 1132) to 28% (177 of 6369; p<0·0001). 268 (2%) of 11 570 participants had undiagnosed HIV and reported UAI in the past year were at risk of transmitting HIV. Additionally 259 (2%) had diagnosed infection and reported UAI and non-exclusive serosorting in the past year. Although we did not collect data on antiretroviral therapy or viral load, surveillance data suggests that a small proportion of men with diagnosed infection will have detectable viral load and hence might also be at risk of transmitting HIV. 2633 (25%) of 10 364 participants were at high risk of acquiring HIV (defined as HIV-negative MSM either reporting one or more casual UAI partners in the past year or not exclusively serosorting). The proportions of MSM at risk of transmission or acquisition changed little over time (p=0·96 for MSM potentially at risk of transmission and p=0·275 for MSM at high risk of acquiring HIV). Undiagnosed men reporting UAI and diagnosed men not exclusively serosorting had consistently higher partner numbers than did other MSM over the period (median ranged from one to three across surveys in undiagnosed men reporting UAI, two to ten in diagnosed men not exclusively serosorting, and none to two in other men). INTERPRETATION An increasing proportion of undiagnosed HIV infections in MSM in London might have been recently acquired, which is when people are likely to be most infectious. High UAI partner numbers of MSM at risk of transmitting HIV and the absence of a significant decrease in the proportion of men at high risk of acquiring the infection might explain the sustained HIV incidence. Implementation of combination prevention interventions comprising both behavioural and biological interventions to reduce community-wide risk is crucial to move towards eradication of HIV. FUNDING Public Health England.
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Affiliation(s)
- Adamma Aghaizu
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Sonali Wayal
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Anthony Nardone
- HIV and STI Department, National Infection Service, Public Health England, London, UK
| | - Victoria Parsons
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Andrew Copas
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Danielle Mercey
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Graham Hart
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Richard Gilson
- Centre for Sexual Health and HIV Research, University College London, London, UK
| | - Anne M Johnson
- Centre for Sexual Health and HIV Research, University College London, London, UK.
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29
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Prah P, Hickson F, Bonell C, McDaid LM, Johnson AM, Wayal S, Clifton S, Sonnenberg P, Nardone A, Erens B, Copas AJ, Riddell J, Weatherburn P, Mercer CH. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect 2016; 92:455-63. [PMID: 26965869 PMCID: PMC5013102 DOI: 10.1136/sextrans-2015-052389] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/06/2016] [Indexed: 11/05/2022] Open
Abstract
Objective To examine sociodemographic and behavioural differences between men who have sex with men (MSM) participating in recent UK convenience surveys and a national probability sample survey. Methods We compared 148 MSM aged 18–64 years interviewed for Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) undertaken in 2010–2012, with men in the same age range participating in contemporaneous convenience surveys of MSM: 15 500 British resident men in the European MSM Internet Survey (EMIS); 797 in the London Gay Men's Sexual Health Survey; and 1234 in Scotland's Gay Men's Sexual Health Survey. Analyses compared men reporting at least one male sexual partner (past year) on similarly worded questions and multivariable analyses accounted for sociodemographic differences between the surveys. Results MSM in convenience surveys were younger and better educated than MSM in Natsal-3, and a larger proportion identified as gay (85%–95% vs 62%). Partner numbers were higher and same-sex anal sex more common in convenience surveys. Unprotected anal intercourse was more commonly reported in EMIS. Compared with Natsal-3, MSM in convenience surveys were more likely to report gonorrhoea diagnoses and HIV testing (both past year). Differences between the samples were reduced when restricting analysis to gay-identifying MSM. Conclusions National probability surveys better reflect the population of MSM but are limited by their smaller samples of MSM. Convenience surveys recruit larger samples of MSM but tend to over-represent MSM identifying as gay and reporting more sexual risk behaviours. Because both sampling strategies have strengths and weaknesses, methods are needed to triangulate data from probability and convenience surveys.
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Affiliation(s)
- Philip Prah
- Research Department of Infection & Population Health, University College London, London, UK
| | - Ford Hickson
- Sigma Research, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Lisa M McDaid
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Anne M Johnson
- Research Department of Infection & Population Health, University College London, London, UK
| | - Sonali Wayal
- Research Department of Infection & Population Health, University College London, London, UK
| | - Soazig Clifton
- Research Department of Infection & Population Health, University College London, London, UK
| | - Pam Sonnenberg
- Research Department of Infection & Population Health, University College London, London, UK
| | | | - Bob Erens
- Research Department of Infection & Population Health, University College London, London, UK Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew J Copas
- Research Department of Infection & Population Health, University College London, London, UK
| | - Julie Riddell
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Peter Weatherburn
- Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Catherine H Mercer
- Research Department of Infection & Population Health, University College London, London, UK
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30
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Bailey J, Mann S, Wayal S, Hunter R, Free C, Abraham C, Murray E. Sexual health promotion for young people delivered via digital media: a scoping review. Public Health Res 2015. [DOI: 10.3310/phr03130] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundYoung people are at risk of poor sexual health and are, therefore, in need of comprehensive, effective sexual health education. Young people are confident and constant users of digital technology, such as the internet and mobile phones, and there are many innovative possibilities for sexual health education involving these technologies.ObjectivesTo summarise evidence on effectiveness, cost-effectiveness and mechanism of action of interactive digital interventions (IDIs) for sexual health; optimal practice for intervention development; contexts for successful implementation; research methods for digital intervention evaluation; and the future potential of sexual health promotion via digital media.DesignLiterature review of evidence on digital interventions for sexual health for young people, integrating the findings with the views of young people, parents and experts in digital media/sexual health. IDIs are defined as digital media programmes that provide health information and tailored decision support, behaviour-change support and/or emotional support. We focus on sexual well-being for young people aged 13–24 years in the UK.ResultsThere are many imaginative IDIs for sexual health promotion, but few interventions address issues that are important to young people, such as sexual pleasure and relationships. It is vital to collaborate with young people and to use Behaviour-Change Theory in designing interventions. We located 19 randomised controlled trials of IDIs for sexual health promotion for young people, finding a moderate effect on sexual health knowledge [standardised mean difference (SMD) 0.54, 95% confidence interval (CI) 0.17 to 0.92], a small effect on confidence (self-efficacy) (SMD 0.11, 95% CI 0.02 to 0.20) and a positive effect on sexual behaviour (odds ratio 1.28, 95% CI 1.01 to 1.61), but no significant effects on safer sex intention or biological outcomes. One study suggests that IDIs may be as good as face-to-face interventions for sexual health knowledge and safer sex intention. There are no existing data on the cost-effectiveness of IDIs for sexual health promotion. The impact of an IDI will be determined by the proportion of the target population reached, intervention efficacy, adoption in a setting, how well it is delivered and maintenance/sustainability. All of these elements must be addressed for IDIs to be successful. More collaboration is needed to capitalise on the knowledge of users and stakeholders, the design and software skills of the commercial sector and the theoretical expertise and evaluation skills of academia.ConclusionsIDIs are effective for knowledge acquisition and sexual behaviour, and could usefully contribute to sexual health education in schools, in clinic settings and online; however, there are obstacles to overcome, such as access to information technology and ensuring the quality and safety of interventions.Future workMore evidence is needed on the best designs for interventions (e.g. choice of behaviour-change mechanisms and interactive features) and the best models of delivery (e.g. setting, modes of delivery, methods of facilitation and support for engagement) to improve sexual behaviour, biological outcomes and sexual well-being in a cost-effective way.FundingThe National Institute for Health Research Public Health Research programme.
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Affiliation(s)
- Julia Bailey
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Sue Mann
- Camberwell Sexual Health Centre, King’s College Hospital, London, UK
| | - Sonali Wayal
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rachael Hunter
- PRIMENT Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Caroline Free
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elizabeth Murray
- e-Health unit, Research Department of Primary Care and Population Health, University College London, London, UK
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Wayal S, Bailey JV, Murray E, Rait G, Morris RW, Peacock R, Nazareth I. P02.01 Systematic review and meta-analysis of randomised control trials of interactive digital interventions for sexual health promotion. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wayal S, Parsons V, Copas A, Danielle M, Nardone A, Aghaizu A, Hart G, Gilson R, Johnson AM. O20.5 Trends in undiagnosed hiv and hiv testing behaviour in community samples of men who have sex with men in london, uk: results from repeat cross-sectional surveys between 2000–2013. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Griffiths C, Mercer C, Gerrussu M, Hughes G. P01.11 Understanding the greater burden of stis among black caribbeans in the uk: evidence from a systematic review. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Prah P, Hickson F, Bonell C, McDaid L, Erens B, Riddell J, Wayal S, Nardone A, Sonnenberg P, Johnson AM, Mercer CH. P11.02 Representing men who have sex with men (msm) in britain: evidence from comparative analyses of the latest convenience and probability surveys. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052270.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Aghaizu A, Nardone A, Copas A, Mercey D, Wayal S, Parsons V, Hart G, Gilson R, Johnson A. O5 Understanding continuing high hiv incidence: sexual behavioural trends among msm in london, 2000–2013. Sex Transm Infect 2015. [DOI: 10.1136/sextrans-2015-052126.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wayal S, Bailey J, Murray E, Rait G, Morris R, Peacock R, Nazareth I. P54 Systematic review and meta-analysis of randomised control trials of interactive digital interventions for sexual health promotion. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.97] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Furegato M, Mohammed H, Wayal S, Mercer C, Hughes G. O6 Measuring the impact of socio-economic deprivation on rates of sexually transmitted infection (STI) diagnoses among black caribbeans in england. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Griffiths C, Mercer C, Gerressu M, Hughes G. P223 Understanding the greater burden of STIS among black caribbeans in the UK: evidence from a systematic review. Br J Vener Dis 2015. [DOI: 10.1136/sextrans-2015-052126.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Fisher M, Wayal S, Smith H, Llewellyn C, Alexander S, Ison C, Parry JV, Singleton G, Perry N, Richardson D. Home sampling for sexually transmitted infections and HIV in men who have sex with men: a prospective observational study. PLoS One 2015; 10:e0120810. [PMID: 25848769 PMCID: PMC4388635 DOI: 10.1371/journal.pone.0120810] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
To determine uptake of home sampling kit (HSK) for STI/HIV compared to clinic-based testing, whether the availability of HSK would increase STI testing rates amongst HIV infected MSM, and those attending a community-based HIV testing clinic compared to historical control. Prospective observational study in three facilities providing STI/HIV testing services in Brighton, UK was conducted. Adult MSM attending/contacting a GUM clinic requesting an STI screen (group 1), HIV infected MSM attending routine outpatient clinic (group 2), and MSM attending a community-based rapid HIV testing service (group 3) were eligible. Participants were required to have no symptomatology consistent with STI and known to be immune to hepatitis A and B (group 1). Eligible men were offered a HSK to obtain self-collected specimens as an alternative to routine testing. HSK uptake compared to conventional clinic-based STI/HIV testing in group 1, increase in STI testing rates due to availability of HSK compared to historical controls in group 2 and 3, and HSK return rates in all settings were calculated. Among the 128 eligible men in group 1, HSK acceptance was higher (62.5% (95% CI: 53.5–70.9)) compared to GUM clinic-based testing (37.5% (95% CI: 29.1–46.5)), (p = 0.0004). Two thirds of eligible MSM offered an HSK in all three groups accepted it, but HSK return rates varied (highest in group 1, 77.5%, lowest in group 3, 16%). HSK for HIV testing was acceptable to 81% of men in group 1. Compared to historical controls, availability of HSK increased the proportion of MSM testing for STIs in group 2 but not in group 3. HSK for STI/HIV offers an alternative to conventional clinic-based testing for MSM seeking STI screening. It significantly increases STI testing uptake in HIV infected MSM. HSK could be considered as an adjunct to clinic-based services to further improve STI/HIV testing in MSM.
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Affiliation(s)
- Martin Fisher
- Department of Genitourinary/HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
- * E-mail:
| | - Sonali Wayal
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Helen Smith
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Carrie Llewellyn
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, United Kingdom
| | - Sarah Alexander
- Public Health England, Sexually Transmitted Bacteria Reference Laboratory and Virus Reference Department, London, United Kingdom
| | - Catherine Ison
- Public Health England, Sexually Transmitted Bacteria Reference Laboratory and Virus Reference Department, London, United Kingdom
| | - John V Parry
- Public Health England, Sexually Transmitted Bacteria Reference Laboratory and Virus Reference Department, London, United Kingdom
| | - Garth Singleton
- Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Nicky Perry
- Department of Genitourinary/HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
| | - Daniel Richardson
- Department of Genitourinary/HIV Medicine, Brighton and Sussex University Hospitals NHS Trust, Brighton, United Kingdom
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Bailey J, Mann S, Wayal S, Abraham C, Murray E. Digital media interventions for sexual health promotion-opportunities and challenges: a great way to reach people, particularly those at increased risk of sexual ill health. BMJ 2015; 350:h1099. [PMID: 25736806 DOI: 10.1136/bmj.h1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Julia Bailey
- eHealth unit, Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Sue Mann
- King's College Hospital NHS Foundation Trust, London, UK
| | - Sonali Wayal
- eHealth unit, Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
| | - Charles Abraham
- Psychology Applied to Health (PatH) Group, University of Exeter Medical School, Exeter, UK
| | - Elizabeth Murray
- eHealth unit, Research Department of Primary Care and Population Health, University College London, London NW3 2PF, UK
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McDonnell J, Haddow L, Daskalopoulou M, Lampe F, Speakman A, Gilson R, Phillips A, Sherr L, Wayal S, Harrison J, Antinori A, Maruff P, Schembri A, Johnson M, Collins S, Rodger A. Minimal cognitive impairment in UK HIV-positive men who have sex with men: effect of case definitions and comparison with the general population and HIV-negative men. J Acquir Immune Defic Syndr 2015; 67:120-7. [PMID: 24991974 PMCID: PMC4175121 DOI: 10.1097/qai.0000000000000273] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is Available in the Text. Background: To determine the prevalence of neurocognitive impairment (NCI) in UK HIV-positive and HIV-negative men who have sex with men (MSM). Methods: HIV-positive and HIV-negative participants were recruited to a cross-sectional study from 2 London clinics and completed computer-assisted neuropsychological tests and questionnaires of depression, anxiety, and activities of daily living. Published definitions of HIV-associated neurocognitive disorders (HAND) and global deficit scores were used. Age- and education-adjusted neuropsychological test scores were directly compared with reference population data. Results: A total of 248 HIV-positive and 45 HIV-negative MSM participated. In the HIV-positive group, median time since diagnosis was 9.4 years, median CD4+ count was 550 cells per cubic millimeter, and 88% were on antiretroviral therapy. Prevalence of HAND was 21.0% in HIV-positive MSM (13.7% asymptomatic neurocognitive impairment, 6.5% mild neurocognitive disorder, and 0.8% HIV-associated dementia). Using a global deficit score threshold of 0.5, the prevalence of NCI was 31.5% (when averaged over 5 neuropsychological domains) and 40.3% (over 10 neuropsychological test scores). These results were not significantly different from the HIV-negative study sample. No consistent pattern of impairment was seen in HIV-positive patients relative to general male population data (n = 380). Conclusions: We found a prevalence of HAND and degree of impairment on neuropsychological testing of HIV-positive MSM that could represent a normal population distribution. These findings suggest that NCI may be overestimated in HIV-positive MSM, and that the attribution of NCI to HIV infection implied by the term HAND requires revision.
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Affiliation(s)
- Jeffrey McDonnell
- *Research Department of Infection and Population Health, University College London, London, United Kingdom; †Department of Medicine, Faculty of Medicine, Imperial College London, London, United Kingdom; ‡National Institute for Infectious Diseases, Lazzaro Spallanzani, Rome, Italy; §CogState, Melbourne, Victoria, Australia; ‖Department of Sexual Health and HIV, Royal Free London NHS Foundation Trust, London, United Kingdom; and ¶HIV I-Base, London, United Kingdom
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Wayal S, Cassell J, Copas A, Edwards S, Hart G. P3.426 The Need and Opportunity to Promote Combination Prevention in HIV Positive Men Who Have Sex with Men Attending Clinics. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Hart G, Edwards S, Cassell J. P4.092 Barriers to Antiretroviral Treatment For HIV Prevention Among HIV+ Men Who Have Sex with Men in the UK: A Qualitative Study. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Hart G, Copas A, Edwards S, Cassell JA. O18 Sexual behaviour, partnership patterns and STI diagnoses among HIV positive MSM: implications for HIV/STIs transmission and partner notification. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601a.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Shahmanesh M, Wayal S, Cowan FM. P89 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601c.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Cassell JA, Edwards S, Hart G. O19 Sexual partnership patterns and sexually transmitted infections in HIV positive men who have sex with men: implications for partner notification. Br J Vener Dis 2012. [DOI: 10.1136/sextrans-2012-050601a.19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wayal S, Cassell J, Scambler G, Hart G, Low N. O5-S3.05 Partner notification for STI And HIV: patients' views and experiences of notifying partners. Sex Transm Infect 2011. [DOI: 10.1136/sextrans-2011-050109.167] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Shahmanesh M, Wayal S, Cowan F. P2-S2.06 Becoming a sex worker: the nexus between violence, gender disadvantage and poverty. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050108.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Wayal S, Cassell J, Copas A, Mercer C, Edwards S, Hart G. O2-S1.04 Effective ART, viral load and sexual behaviour of HIV positive men who have sex with men: changes from 2000 to 2010. Br J Vener Dis 2011. [DOI: 10.1136/sextrans-2011-050109.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Wayal S, Llewellyn C, Smith H, Fisher M. Home sampling kits for sexually transmitted infections: preferences and concerns of men who have sex with men. Cult Health Sex 2011; 13:343-353. [PMID: 21154069 DOI: 10.1080/13691058.2010.535018] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The increasing prevalence of sexually transmitted infection (STI) and delays in access to sexual health care among men who have sex with men are a major public health concern in the UK. This qualitative study, involving semi-structured interviews with 24 men recruited from a genitourinary medicine clinic in Brighton, UK, explored their views towards the introduction of home sampling kits for STI into clinical practice. Participants had previously self-sampled for rectal and oropharyngeal specimens and completed a survey on the acceptability of self-sampling. Interviews were audio-recorded, transcribed and analyzed using a framework approach. Participants preferred to access home sampling kits from medical venues rather than gay social venues due to privacy concerns and fear of being ridiculed by peers. Perceived societal homophobia led to skepticism towards accessing home sampling kits in commercial venues. Assurance about specimen delivery and receiving test results from clinics was important. Views about using home sampling kits for HIV testing were mixed. Home sampling kits were viewed as an adjunct to clinics, but clinic attendance was preferred if symptomatic. Home sampling kits could be a viable alternative to meet the increasing demand for sexual health services, but to improve the home sampling kit uptake the method of service provision must be culturally sensitive and acceptable.
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Affiliation(s)
- Sonali Wayal
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
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