Patient perspectives on the implementation of routinised syphilis screening with HIV viral load testing: Qualitative process evaluation of the Enhanced Syphilis Screening Among HIV-positive Men trial

Kinnon R Mackinnon,Rodney Rousseau,Ann N Burchell,Ramandip Grewal,Paul A Macpherson,Anita Rachlis,Darrell Hs Tan,Sharon Walmsley,John Maxwell,Sharmistha Mishra,Nisha Andany,Vanessa G Allen

doi:10.1186/s12913-021-06602-1

Abstract

BackgroundSyphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake.MethodsUpon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing.ResultsA total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing.ConclusionsOverall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing.Trial registrationClinicalTrials.gov NCT02019043; registered December 23, 2013.

Highlights

Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately
Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care
HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing

Summary

Introduction

Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Rates of syphilis and other bacterial sexually transmitted infections (STIs) have increased dramatically among men living with HIV in North America, Europe, and Australia [1]. International guidelines recommend syphilis screening for people with HIV at least once per year, with some advising more frequent testing at 3–6 month intervals [3,4,5,6]. Canadian STI Guidelines recommend screening for bacterial STIs, including syphilis, at 3month intervals in the absence of symptoms for individuals identified as at ongoing risk [3]. Asymptomatic syphilis can occur, among men living with HIV and among those who have previously had syphilis and are reinfected [7, 8]

Methods

Results

Discussion

Conclusion